Injured in NY, Treated in Another State: How to Manage Injured Workers Crossing State Lines
An employee is injured in a New York laboratory where she’s worked for the past five years. The company is headquartered in Maryland with additional locations in Florida, Tennessee and Delaware. The injured worker lives and wishes to seek treatment in New Jersey. What happens next?
Each state has its own guidelines for governing workers’ compensation cases, including how coverage is provided, the benefits an employee can/cannot collect and what is required of employers, injured workers, providers and insurance companies during the medical claims process.
At Viscardi, we handle some of the most complex medical management cases, including state-crossing scenarios similar to the above. Here’s how to determine the jurisdiction for a worker’s compensation where an employee is injured in NY and living elsewhere.
The W.A.L.S.H. Test
When it comes to cross-state cases, the first and most important criteria to identify is the ruling state. Which state is responsible for handling the injured worker’s case?
To do so, the W.A.L.S.H. test is applied. W.A.L.S.H. stands for Worked, Accident, Lived, Salaried and Hired.
W: Where does the employee work?
A: Where was the accident?
L: Where does she live?
S: Where is she salaried?
H: Where was she hired?
Each of the five criteria is weighted differently, with where the employee works and where the accident occurred having the highest relevance since they’re most closely related to the incident.
The insurance company makes the initial determination of jurisdiction. If there is a dispute on that determination, then it goes to a judge. In the example above, a judge would rule that New York has jurisdiction over the case since the injured worker both worked and was injured in New York.
Piggybacking
Piggybacking is when an employee files for benefits in two states where they qualify (like if the employee in the example above filed for benefits in both New York and New Jersey). Usually, if an employee successfully receives benefits in both the first and second states, the benefits from the first state are offset by the payment of the second. But an employee’s ability to receive payments from two states and how those payments are divided depends on the workers’ compensation guidelines in each state.
For these reasons, cross-state cases include an additional layer of processes and stakeholders and are often the most complex. Here at Viscardi, we are experts on cross-state workers’ compensation cases. Don’t hesitate to get in touch if you have any questions or need help navigating your employees through a cross-state case.