Workers’ Compensation

Goldberg Segalla is home to the most sophisticated construction defense practice in the industry. We specialize in representing large contractors, construction managers, and owners, with deep experience in OCIP (Owner Controlled Insurance Program) and CCIP (Contractor Controlled Insurance Program) site-specific and rolling wrap-up programs ranging from major commercial development to cross-border natural gas pipeline projects. Serving clients across our nationwide footprint, we offer an integrated suite of construction services including workers’ compensation, general liability, construction defect, insurance coverage, and construction contract and commercial litigation. Practice highlights include:

• First ever workers’ compensation and general liability joint defense program for OCIP/CCIP in New York State
• Mastery of workers’ compensation liens, global settlements, and mediation
• National OSHA team including multiple litigators with OSHA 30-hour training, equipped to assist with both litigation and regulatory matters involving multiple federal and state agencies
• Robust Construction Site Personal Injury practice staffed by trial-tested attorneys — including a Rapid Incident Response team — with a deep understanding of the changing daily worksite environment, standard and specialty equipment, and the roles of the general contractor and subcontractors on site
• Dedicated transactional attorneys and commercial litigators offer counsel and defense wherever contracts come into play

Goldberg Segalla’s workers’ compensation practice in the health care sector is a one-stop shop for national and regional health care providers. It is distinguished by our deep engagement with health care companies and the professionals who manage, direct, and insure them. From labor unions to leave of absence to return-to-work issues, we understand the unique needs of health care providers. We work as a team with employers and claims professionals to meet these needs. Our workers’ compensation teams also collaborate with attorneys in our Employment and Labor practice to address any employment issues that may be impacted by workers’ compensation decisions. Some highlights of our practice include:

• National integrated team that includes multiple litigators who specialize in the health care field working together to mitigate damages and costs across the board
• Inter-state collaboration to meet large employers’ unique needs, including tailored approaches for national hospitals, nursing homes, and other health care industry employers
• Team members who are former in-house counsel at health care companies, board members at hospitals and ER facilities, and leaders in multiple legal and professional organizations focused on health care and long-term care

In addition to our workers’ compensation capabilities, Goldberg Segalla has a dedicated and multidisciplinary Health Care industry group, equipped to counsel and defend health care companies, executives, professionals, and insurers through the full range of legal issues affecting the industry. Our services include general liability defense, regulatory counsel and risk management, malpractice and professional liability, business and commercial disputes, employment litigation and counseling, union negotiations and other traditional labor law matters, internal investigations, cybersecurity and information privacy, environmental compliance and litigation, insurance coverage, corporate law and transactions, and OSHA and worksite safety.

Goldberg Segalla has long served as a trusted advisor and steadfast protector of the manufacturing industry—and this includes defense of workers’ compensation claims, ranging from common occupational conditions to catastrophic injuries and fatalities. We have experience with the unique demands of workers’ compensation in this industry, from handling rapid-response on-site investigations to collaborating with colleagues across our practice groups to create tailored claims-closure and risk-reduction plans. Highlights of our manufacturing workers’ compensation practice include:

• Vast experience defending common repetitive stress/strain claims such as carpal tunnel, cubital tunnel, and osteoarthritis of the upper extremities
• Dedicated national investigations counsel and 24/7 rapid incident response team
• A dedicated team of experienced OSHA attorneys whose practice capabilities span a broad range of federal and state OSHA issues
• A dedicated team of attorneys to assist in the drafting, review, and implementation of safety programs compliant with OSHA and other applicable regulations
• Certified Fire and Explosion Investigator (CFEI)
• Veteran traditional labor law attorneys with experience handling the interactions between unions/collective bargaining agreements and workers’ compensation claims
• Multiple attorneys with hands-on industry experience, including:
  • More than a decade working as an industrial hygienist advising large companies on regulatory issues related to occupational exposure
  • Designing air and spacecraft wing and fuselage structures as an aerospace engineer
  • Nearly a decade as an aircraft maintenance and repair technician
  • Working in global supply chain logistics and freight management

In addition, our multidisciplinary Manufacturing industry group frequently defends and counsels leading national and international manufacturers with matters including product liability and product recall, class action defense, risk and litigation avoidance, toxic torts, insurance coverage, regulatory compliance, OSHA litigation, data security and cyber risks, real estate leasing and litigation, and employment and labor.

We also contribute extensively to judicial and tort reform efforts. We actively and proudly encourage these efforts through our support of, and membership in, organizations such as Lawyers for Civil Justice and the Defense Research Institute. Our lawyers also prepare and submit amicus briefs on behalf of the Product Liability Advisory Counsel (PLAC). In fact, our team is proud to have six members of the PLAC, a highly selective group of leading product manufacturers and the most elite product liability defense counsels operating in the U.S. and abroad, who have taken the PLAC oath never to represent a party against a manufacturer.

Disruptions of industries and enhancements in information technology provide exciting new cultivation opportunities to professional employer organizations (PEO) and technology companies operating in the national gig economy. However, major players in new or evolving markets attract risk, scrutiny, and the attention of the plaintiffs’ bar. As a firm founded by trial lawyers, and with a reputation for continuously improving practices, Goldberg Segalla is exceptionally well positioned to counsel and defend PEO and gig economy clients through the changes and challenges of the 21st century.

• Goldberg Segalla attorneys recognize the need to support the PEO-client relationship by minimizing interference with the client company’s business while aggressively seeking claim closure
• When necessary, we employ an innovative and aggressive evidence-based defense for PEOs facing workers’ compensation claims filed by employees of former clients or direct employees of current clients—often parachuting in to take on late-stage claims from other counsel
• We boast an exceptional success rate in securing dismissal of New York claims filed against technology companies operating in the gig economy or settling them before trial

In addition, with national Construction and Trucking/Transportation practice groups, we are well versed not just in the PEO industry but also in industries of significant market value to PEOs.

As counsel to many of the globe’s leading retailers, developers, and hospitality companies, Goldberg Segalla offers strong defense, comprehensive counsel, and long-term strategic guidance. We partner with our clients to help them achieve their long-term strategic goals—and we’re also committed to the health of their industries, as active members of the National Retail and Restaurant Defense Association (NRRDA), Associated Builders and Contractors (ABC), and Associated General Contractors (AGC), as well as retail and hospitality groups and committees within DRI and CLM. Some highlights of our practice include:

• Interdisciplinary long-term cost-reduction programs for workers’ compensation and employment, including the Opioid Impact Program, Medicare Compliance and Strategic Settlement Planning, Integrated Disability and Workforce Management, and state-specific Quick-Closure Programs
• Legacy settlement projects designed to close long-tail comp claims and significantly reduce claim inventory and overall exposure

Our coast-to-coast Sports and Entertainment team understands the issues unique to these interconnected industries. We assist entertainment studios, global media companies, major league sports franchises, and related entities with all types of workers compensation concerns, as well as employment and labor, general defense, cybersecurity, patent infringement, transactions and contracts, and other matters. Practice highlights include:

• Facilitation of industry-wide joint defense programs geared toward creating employer control and cost-savings
• Proactive claim-closure strategies for everyday work-related injuries as well as occupational disease and cumulative trauma claims, including traumatic brain injury litigation
• Internal partnerships with franchises, studios, brokers, and other companies for generation of value-added services and fast, effective litigation plans
• Deep industry experience—including attorneys with decades spent immersed in the unique issues affecting these fields, as well as former major league, minor league, and NCAA athletes

With strategic coverage along the I-95 corridor, in the Midwest in Illinois and Missouri, and most recently in southern California, Goldberg Segalla’s interdisciplinary Transportation practice is a one-stop legal shop for leading trucking and other transportation companies, equipped to handle all of the legal risks, needs, and other issues unique to the industry. Actively affiliated with the Trucking Industry Defense Association (TIDA) and the Trucking Law Committee of the Defense Research Institute as well as various state trucking associations, and drawing on valuable in-house experience, this integrated team’s capabilities span workers’ compensation, labor and employment, insurance coverage, and litigation over catastrophic injury and death, property damage, products, and other liability claims. Practice highlights include:

• Workers’ compensation claims-handling model and global closure strategy built on a.) one attorney per file, b.) early and consistent reporting, and c.) quick closure—all tailored to avoid unnecessary legal spending
• Value-added programs targeted at alleviating pressure points affecting trucking workers’ compensation claims, including a proven light-duty return-to-work program and a pioneering Opioid Impact Program
• Extensive trial and litigation experience in catastrophic injury, death, and property damage cases, including serving as regional coordinating counsel for major international trucking and logistics companies
• Backed by 24/7 Emergency Response Team and former FBI office head investigations counsel always on call

Goldberg Segalla’s Workers’ Compensation practice group brings clients a distinct competitive advantage to the defense of claims through our exceptional ability to handle Medicare Set-Asides (MSAs), the allocations for the future medical costs of an individual on Medicare (or soon to be on it) following the settlement of a case.

Tackling the MSA proactively often makes a significant difference in obtaining a lower settlement cost. Developing and implementing the right strategy for each individual case requires an intimate knowledge of the Centers for Medicare and Medicaid Services (CMS) pre-approval process as well as proper negotiations with CMS.

Our team possesses extraordinary qualifications in this area through S. Philip Unwin and Jennifer B. Santoro, who have earned the credential of Medicare Set-Aside Certified Consultant. Their pre-approved training in Medicare Set-Aside trust arrangements—coupled with years of experience calculating Medicare Set-Asides, applying for approval, and investigating conditional payments—resonates with other parties during the negotiation process and greatly enhances our ability to achieve the lowest possible MSA amount.

This experience can benefit clients and carriers across the country and beyond the realm of workers’ compensation. The question of whether an MSA should be established is also very important to address in any general liability case in which the plaintiff is a Medicare beneficiary, the plaintiff is anticipated to be enrolled in Medicare by the time of settlement, or the plaintiff will require lifetime medical care as a result of his or her injuries.

To learn more about how our MSA capabilities may benefit you, contact Philip Unwin at 585.295.8340 or punwin@goldbergsegalla.com.

Goldberg Segalla offers a comprehensive Opioid Impact Program (OIP) that helps claims professionals reduce claimants’ use of prescription medications and identify and mitigate claims that have the potential to spiral out of control in terms of cost and exposure.

Our OIP employs an early identification strategy to educate claims professionals on the key indicators of potentially problematic cases involving opioids and prescription drugs. It also sets forth a specific protocol to limit new prescriptions for new and older cases, along with a detailed blueprint on how to isolate, identify, and reduce claims with high prescription medication costs.

In New York State, the Health Insurance Matching Program – widely known as HIMP – provides a means for a claimant’s private health insurer to obtain reimbursement for treatment they believe a workers’ compensation carrier or self-insured employer should have paid.

In this complex process, a claimant’s private health insurer must receive a “match” from the New York State Workers’ Compensation Board before serving a demand via the HIMP-1 form. The remainder of the HIMP process takes place before the American Arbitration Association’s HIMP Unit. However, because there are some forgiving deadlines, HIMP-1 demands can show up years after a “full and final” Section 32 waiver agreement – and still be payable. In fact, sometimes HIMP exposure can be tens, or even hundreds, of thousands of dollars for denied treatment that would have otherwise been completely defensible had it been adjudicated before the board.

Goldberg Segalla’s dedicated HIMP-1 defense team can help you anticipate a HIMP-1 exposure and prepare a comprehensive defense on your behalf. At minimum, the NYS Workers’ Compensation medical fee schedule applies as an objection in almost every HIMP matter. Other viable defenses include timeliness, causal relationship, treatment inconsistent with the Medical Treatment Guidelines, and a Section 29 “Burns credit,” among others.

Whether it’s preparing and serving formal objections, negotiating settlements when warranted, or appearing before the American Arbitration Association, Goldberg Segalla’s experience in the arena of HIMP-1 Workers’ Compensation defense runs deep and we stand ready to help you navigate this often-complicated process.

Workers’ compensation claims, employee health care, reasonable accommodation and leave management policies, compliance with state and federal regulations, litigation, and transactional matters – all these challenges and costs are part of the operational landscape for employers competing in any industry. Unfortunately, most employers are not equipped to treat these issues like a landscape – that is, with adaptable, efficient, and global solutions. The byproducts of siloed approaches are often cost inefficiencies, liability, and greater risk.

We developed the Integrated Disability and Workforce Management Program to mitigate those costs and correct those inefficiencies. The program offers comprehensive solutions to disability, leave, performance, and health management issues, adaptable to any situation, any budget, and any set of needs. Drawing selectively on the full scope of our firm’s collective experience – with more than 450 outstanding attorneys ready to weigh in and assist with countless highly specialized concerns – we are able to provide our clients with a 360-degree assessment, address inefficiencies, and craft comprehensive and cost-efficient solutions.

Goldberg Segalla’s subrogation practice is perfectly positioned to assist insurance carriers with the necessary tools and mechanisms to recover previously paid benefits and offset future exposure. Our robust subrogation team demonstrates a vast, wide-ranging expertise in statutory, regulatory, and ever-evolving case law to evaluate all options and ensure maximum recoveries.

Because Goldberg Segalla offers expertise in areas of law outside workers’ compensation, we possess the unique advantage of having general liability experts on-hand to evaluate the merits of GL claims to further understand and consider the nuanced details of liability when an offer is made and how best to mitigate future exposure. We partner with clients from inception of the case through closure, including handling investigation, issuing lien letters, and drafting consent letters. Practice highlights include:

• Closely monitoring the status of applicable third-party actions
• Regularly providing lien notices to third parties
• Appearing at mediation to ensure preservation of all possible subrogation interests
• Ensuring both maximum lien recoveries as well as maximizing future offsets
• Evaluating possible third-party lien/offset compromises in an effort to additionally shut down workers’ compensation claims for a significantly reduced amount
• Determining the applicability of loss transfer to potentially obtain additional recovery beyond the enforceable lien/offset
• Handling HIMP filings