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Workers’ Compensation FAQ's

Our Primary emphasis is Handling WCL Cases in Nassau and Suffolk Counties, for Injured Long Island Workers.

Eliot Levine and Associates is a law firm that handles Workers’ Compensation cases on Long Island. We prefer to attend hearings on cases in Suffolk County and Eastern Long Island, We accept clients who live in the surrounding areas of Hauppauge, Smithtown, Commack, Kings Park, Huntington, Huntington Station, Brentwood, Islip, C.I. , Central Islip, Patchogue, Port Jefferson Station, Shirley, Ridge, and Riverhead to name a few. We readily represent workers, before the Workers’ Compensation Board at all WCB hearing points on Long Island. This has taken us to Nassau, Suffolk and Queens Counties. Over the years; the WCB has maintained various hearing points in Hempstead, Bay Shore, Hauppauge, Medford, Patchogue and Riverhead. Such hearing points are subject to change and we intend to continue covering all such hearing points as they present themselves. Whether you live in one of the above locations or not; we will represent you on any New York State Workers’ Compensation case should you retain our firm. In special situations, we also represent uninsured employers before the WCB.


Are there any reimbursements in Compensation?

Reimbursement for causally related prescription costs and mileage are available subject to limitations found in the WCL, WCB rules and case law. At the time of this writing, mileage reimbursements are payable at 55.5 cents a mile. Mileage reimbursement rates have changed over time and are controlled by the date of the service as documented in the rules and regulations of the WCL. You are permitted to receive such reimbursements for traveling to and from those health providers handling your case as well as for transportation costs associated with examinations conducted and set up by insurance companies monitoring your case. Transportation costs to and from the court or your attorney are not reimbursable.

Covered medical prescription costs may be reimbursable if you comply with the procedures set out in the act but primarily must be documented as "medically necessary". Such products and devices must be requested by your health provider and are subject to challenge if not medically necessary. Routine procedures are detailed in the Medical Treatment Guidelines, WCL and WCB rules and regulations as well as procedures for obtaining such services but, may be reimbursable if approved by the insurance provider in advance or after board direction.

Health provider are not permitted to charge and receive payments for causally related medical services from workers' compensation claimants. If any such payment is made, the payment is not reimbursable. If such a payment is made for a compensable claim, it is illegal and not enforceable.

If your employer has made advance payments for causally related care, reimbursements can be directed by the WCB. In addition, various payments made under contract or state law in certain circumstances and subject to contract documents may also be reimbursable to the entity making the payment. If a non-employer and non co-employee is negligent and the cause of the injury; then they could be found to be ultimately liable for all compensation costs in the case subject to the amounts contained in the negligent or malpractice action. This is known as a third party case. As such, the negligent party and its insurance provider can be compelled to reimburse the workers' compensation provider who has already paid or create a credit to the benefit of the compensation provider to future obligations equal to the amounts contained in the third party case subject to case law regarding apportionment issues. Detailed discussion on these issues are contained in the "Kelly" and "Burns" cases and their progeny. ( See standard disclaimer as noted below.)


How do I get my injuries treated ?

Under the present Rules and Regulations as promulgated by the WCB as exemplified by the latest Medical Treatment Guidelines ( MTG ) effective December 1, 2010 injuries effecting arms, knees backs and necks are described in a detailed 200 page document available to all individuals participating in the workers compensation system . This document tries to provide and permit standard medical practices for many types of medical conditions. When treatment or conditions are not found or fully handled in the MTG, the health provider may file a variance to the MTG and then procedural requirements exist to eventually resolve any dispute. The question arises as to how these variances should be evaluated. The present system permits either medical arbitration or WCL judges review. When the question goes to a law judge, the difficulty develops as to what is the medical basis that the judge can use to review and decide such issues. On a simplified approach the judges can rule based upon whether the health provider has met their burden of proof. When this means is there any evidence submitted then the judge has no problem making a decision. When the issue is comparing medical opinion on reasons for one type of medical form of treatment over another; a strong complaint can be made that the judge is not legally competent to give or evaluate such medical opinion. They should be able to hear the reasons presented but do not have the medical expertise to weigh one opinion over another. If the procedure is not prohibited by the guidelines and a health provider can explain why such a procedure is appropriate consistent with present medical custom and usage then only an impartial medical expert should be used to resolve the dispute not a law judge. This is the very nub of the problem with the medical guidelines as they presently exist., The issue gets murkier when only one side provides a medical opinion from a licensed medical provider. We'll have to see how this develops as more cases are presented and litigated.



Why does it take so long to get a hearing?

The Compensation Law, according to Legislative History, was designed to provide injured workers with relatively quick wage replacement payments and treatment for causally related injuries in exchange for giving up claims of negligence against the employer or coworker. It was expected that this would eliminate delays due to extensive litigation. Somewhere along the line of cases and applications of the law, contested cases became the norm on the very issues of compensabilty and medical care. This has been made more devastating by the Workers' Compensation Board's use of the Medical Treatment Guidelines effective December 1, 2010.

Recent statistic show more than 250,000 variance applications have been filed with the WCB, contesting the restrictions and interpretations of the Medical Treatment Guidelines. This contest has back logged the hearing process and presently clogs the system. Only so many cases can be heard and processed by the WCB at a given time. The State Legislature, as stated earlier in this blog, has been grappling with this problem and beginning last summer, has indicated a bill would reach the Governor's desk soon. At this time, only the State Assembly has approved legislation limiting the retro-activity of the Medical Treatment Guidelines referenced above. We await further governmental action on this issue.



Who has jurisdiction over a compensation case?

In New York State , the WCL is the statute that gives exclusive jurisdiction over all workers' compensation cases to the Workers' Compensation Board. No civil court has the legal right ( jurisdiction) to determines the rights and responsibilities of the parties under or out of the the work place setting. In fact, case law requires such other legal bodies and courts to defer to the interpretations of the WCB unless a specific issue or claim is appealed to the Appellate Division of the New York Supreme Court , Third Department. These other bodies lack authority over these matters and any action to bring review before them are subject to dismissal for lack of subject matter jurisdiction. This is known as exclusivity of jurisdiction. In its' simplest form, parties to the workers' compensation case are the claimant, ( injured worker) and usually the employer who are permitted to obtain legal representatives to appear and represent their issues before the WCB. Additional parties may also be added, as required, due to complexity of issues presented.


What is an Occupational disease?

Workers' Compensation protects workers who develop medial or psychological difficulties or ailments from long time exposures derived from the workplace. Such conditions may develop into occupational diseases when they grow out of or from the work environment and usually occur over extended periods of time. This does not mean that just because you discover that you have a medical problem while you were at work that it is compensable. An occupational disease must be a condition that develops from the exposure at work and be normally associated with the specific type of job activity that you perform regularly over time, "nature of the work" is a term normally associated with such claims. One time exposures are normally considered accidents. Repetitive exposures create a basis for claims of occupational diseases.

Some occupational diseases are lung ailments derived from slow acting dust diseases, carpal tunnel conditions associated with typing, eye or neck problems caused by constant use of computer screens, knee injuries for carpet installer using kick devices. In short; to have a proper claim, the condition must be developed from repetitive activity, not a one time episode. If you notice a one time episode it is more readily established as being caused by the one time event at a specific time and place, hence an injury. Occupational diseases are more indefinite as to a specific time of the occurrence or time constraints but , filing for and establishing successful claims are still controlled by special time limitations as found in the WCL. Ultimately, regardless of the condition, evidence is still required to prove causal relation. Such exposure must be supported by medical / expert opinion to support the claim. Not all doctors readily associate the presenting symptom with a longitudinal exposure. Everyone can immediately understand that a back, leg or arm injury can occur from a slip and fall. It becomes more difficult to understand and appreciate the time line associated with underlining occupational exposures.

For these types of claims as in all Workers' Compensation claims, it is best to consult a legal representative for detailed advise. Hence as stated throughout these discussions, no attorney client relationship is established by these blogs and all such discussion is limited by my Disclaimer found throughout these articles.


Do I need a Lawyer?

There is no reguirement under the WCL for you to be represented by a lawyer. You can represent yourself. Therefore, technically, you do not need a legal representative. The reality of the process illustrates that the insurance companies are either represented by lawyers or company hearing representatives who are trained to protect the rights and funds
of the insurance company. The WCB is the trier of fact and interpreter of the law. When you are not represented, this becomes a one sided process. Even though the compensation law was set up for the judges to review facts presented and if possible give some balance to the case before them; time constraints and other realities of the hearing process along with the ever escalating rules and regulations existent in the Workers' Compensation process prevent or retard unrepresented claimants from getting an equal chance. Some statistics have been presented that conclude that represented claimants obtain higher benefits then those individuals left without proper representation.
The WCL has become a highly technical process and those individuals not fully informed and knowledgeable of its twists and turns (sinews) can suffer delays if not worse.

Sec 24 of the WCL, details how and under what circumstances your representative can be paid. No payment is ever permitted directly from the claimant to the representative. Fees are earned based upon results and subject to an evaluation of services rendered by the trier of fact
( usually a Judge) on a case by case basis. Under these circumstances, no payment for attorneys services can be made without WCB approval. Attorneys fees for representation comes out of and are deducted from successful awards of indemnity benefits. Claimants are equally not responsible for payment to health providers for causally related health related services. These services are also regulated by the WCL and the Medical Treatment Guidelines and their interpretations by the WCB and Court System.


What is a sec 32 settlement?

Under the Workers' Compensation Law (WCL) there is a precise section of the law that permits final resolution of your claim for indemnity and medical benefits.This section is known as Section 32 of the WCL. It is a formal agreement, presented to the WCB where the parties resolve all issues and is not subject to an appeal by any side. ( ie., any party).
In some but not all cases, all rights including medical responsibilities for future causally related problems / care are eliminated. Since the WCL was created as the exclusive forum to resolve and bring claims for on the job injuries or occupational diseases caused by the work environment; the WCL does not permit unintended waivers of the protections under the WCL. Since a section 32 settlement alters the parties rights; the WCB does not permit these rights to be waived or modified lightly.

Therefore, a section 32 claim is presented in writing and attested to by the parties before the WCB in a formal hearing setting. The Workers Compensation Board requires the claimant to be questioned about the content of their settlement and their understanding of same. The trier of fact , usually a law judge, has to determine whether the claimant and all parties understand the full implications of such an agreement. The law judges are given wide latitude in evaluating whether the claimants are fully aware ( cognizant) of the significance of the settlement agreement. The formal determination of the WCB requires a 10 day cooling off period after the presentation of the settlement to the trier of fact
( usually judge) before the agreement can be published and becomes final and binding.

At the present time, when you want to settle your case by way of sec 32, future medical costs based upon past treatment and prescription usage can be subject to review by the Federal Government for those individuals on Medicare or who are Medicare eligible within 30 months of the settlement. This review is known as obtaining CMS approval. Due to the
back log of cases, such CMS review and approval has been taking more than 180 calendar days after formal submission for approval has been made to the agency authorized to make such approvals.

As stated throughout this blog all cases are different and require detailed discussion with your legal representative and therefore this blog should be read in such context and the Disclaimer found throughout. These discussions are just that , discussion for educational purposes on general areas and are not case specific.


How long can I collect compensation?

Generally speaking, once your compensation case has been established, you can receive indemnity benefits for 18 years and reopen your case for medicals benefits forever. These long term issues are subject to specific conditions and terms contained in the WCL. Some of these rights are dependent upon findings of permanency. If you have a permanent partial or permanent total condition, your indemnity benefits can continue subject to specific limitations found in the WCL. If you return to work, certain kinds of cases permit the WCB to grant a specified monetary award. These are usually known as schedule loss of use awards
or awards for periods of time where wage loss occurs. In other cases, you may even be classified as having a causally related permanent condition which may entitle you to continuing indemnity and medical benefits. If your case has not been established or properly filed, special time periods control. Generally, a case must be filed within two
years from the date of the incident and notice of the incident must be given to your employer with 30 days from the incident. All cases require a causal connection exist before benefits of any type can be established. Evidence of such a causally connection is contained in the reports and opinions of a medical provider. The opinions of your health provider are contrasted with the opinions of health related witness for your employers' benefit provider.

As continuously stated, please note my disclaimer found throughout these blogs. This blog is merely provided for educational and general discussion purposes. It is not specific legal advise on any specific case. For any formal advise, a retainer agreement and face to face representation should occur. All situations have nuances that are fact and law dependent and can only be truly reviewed in such a relationship.


How much money do I get from my Compensation case?

Your indemnity payment for the condition causing your compensation injury or disease is dependent upon your earnings from the one year immediately preceding the date of your injury or occupational disease. This is known as your average working wage ( AWW) . Once this is determined the maximum indemnity weekly benefit under Workers' Compensation in New York can be no more that 2/3 of that AWW. These maximum indemnity payments are limited to weekly maximums dependent upon the year of the injury. These rates have changed over the years and are specified in the statute. The maximum weekly benefit rate a disabled worker can receive presumes the worker is out of work and totally disabled. Once you go back to work or your causally related condition improves, your rate of indemnity per week can be reduced. This is usually resolved after evidence is presented and a formal decision is rendered by the Workers' Compensation Board., ( WCB). If you are receiving benefits before or without a formal award, such payments are subject to the New York State Workers' Compensation Law and are somewhat voluntary. You are best protected by a formal decision of
the WCB which relies upon medical evidence related to the case.

Under various situations, dependent upon the date of your compensible disability, your right to continuing benefits remains. Your right to medical care subject to the WCL continues but is limited by the Medical Treatment Guideline and their interpretations. Your right to continuing indemnity payments continues subject to the type of case, condition and findings on the case. In some instances, payments can continue forever but are limited by the requirements spelled out in the WCL and court cases interpreting the WCL. As stated throughout this blog, each case is different and all specific questions regarding your case should be discussed with your legal representative. ( see disclaimer)


Is my comp taxable?

Generally speaking, New York Sate Workers' Compensation Benefits are not taxable. There are situations where because you receive combinations of benefits, such as Social Security Benefits and New York State Workers' Compensation Benefits, that may effectively create a taxable event. If your other form of benefit is reduced by the compensation payment this can in some instances create a tax on the amount of the credited reduction. It is best to consult your tax adviser when considering tax questions.


Who pays for my lawyer?

Under the New York State Workers' Compensation Law, (WCL), the injured worker is not directly responsible for the payment of attorneys fees. The law prohibits an attorney from collecting any money from the claimant. All fees for legal services are controlled by the WCL and must be approved by the Workers' Compensation Board ( WCB ) . When approved, such fees are paid by the insurance provider aka insurance company and the amount of the fee is deducted from the award issued by the Workers' Compensation Board. The workers' payment for lost wages are known as indemnity payments and are reduced by the amount of the approved fee. Such fees are usually limited. The customary fee has been limited to between 10 and 20% of the new money presented in the award notice. The award notice is the formal
written decision of the WCB publishing the decision of the trier of fact who is authorized to render a formal decision on the case before the WCB. Fees are not approved for indemnity payments voluntarily made by the insurance provider. The fees are calculated on new money
approved in the board decision. In some situations, an attorneys' fee can be deducted from reimbursements represented in an award of moneys going back to the employer for advance payments of compensation. ( see formal disclaimer in prior blogs).


Who pays for treatment in Workers' Compensation Cases?

Under the New York Workers' Compensation system , injured employees causally related medical care is controlled by various sections of the New York Workers' Compensation Law , ( WCL). Generally speaking, such care is not the responsibility of the injured worker but rather the responsibility of the employers' workers' compensation insurance provider. If the employer fails to obtain or maintain such coverage, the WCL created a fund to cover such treatment responsibilities as well as indemnity issues. This Fund is known as the Uninsured Employers Fund.

There are no deductibles nor co-payments by workers nor anyone else. If the procedure or treatment has been properly provided or properly requested and complies with the WCL the injured worker is exempt from any financial obligation in respect to such care. If the provision of such causally related healthcare fails to meet the standards and procedures
for obtaining payment to the health care provider; such care is not the responsibility of the injured worker. The claimant /worker is exempt from any financial responsibly for same. It is illegal for a provider of such causally related care to request or compel payment from the patient.

The real issue has become more vexing since the creation of the newest Medical Treatment Guidelines effective 12/1/2010. These regulation and practices have been promulgated with the stated intent to quicken the process for obtaining medical care under the WCL. At the present time, delays seem to have been created and questions remain regarding these
Guidelines and their interpretation as well as authority. The New York State Legislature is presently, reviewing laws on these issues. We'll see what develops. Further commentary will follow in later blogs.

As always, note my disclaimer, these discussions are merely just that, a discussion and not formal legal advise which should be conducted in a face to face retainer relationship with an attorney or legal representative and would be fact and law sensitive to each separate case presented.


What is a Wisc?

A WISC ( Walk in stipulation calendar) is a special agreement whereby the parties to a compensation case can resolve issues on any part of a New York State Workers' Compensation case. They require a formal written stipulation where the parties to the claim formally agree to a result on any part of or on the full case. The matters contained in
the agreement becomes effective and formal upon approval by the Workers' Compensation Board, (WCB) . No party can compel the other to accept such an agreement unilaterally but, once obtained, this device is used to expedite a formal decision of the WCB. The WISC devise was created to permit fast resolutions of limited issues not requiring full
development of a record and is limited to the four corners of the written agreement. Because it is a "mutual understanding" the WCB tries to permit quick calendar action for these agreements. The contents of such an agreement usually covers treatment, loss of time, permanency, disability, salary disputes monetary awards or any item normally contained in a case without the need for detailed discussion, presentation of evidence or argument. It is just that, a stipulation containing those areas where the parties can agree. Once published
by the WCB it becomes legally binding on the parties to the agreement.

( As stated throughout these blog discussions; they are provided for educative and informative purposes and are not intended to be a substitute for formal legal advise on a specific issue or state of facts and should be reviewed in a formal legal relationship with an attorney or legal representative. The discussions as presented do not create a formal attorney client relationship. All situations vary and are usually fact and law dependent which also may vary or be effected by the law in existence at the time of the occurrence.)


What is a Comp Hearing?

A Comp ( Workers' Compensation) Hearing is a statutory right whereby a claim for benefits from an on the job injury or occupational disability is presented. The nature of the " Hearing" has in recent times been under attack. Traditionally, a hearing has been the presentation "in person" before a trier of fact, usually a law judge but not always with a presentation of the claim through documentation and/or oral evidence. All parties to the claim have the right to representation by someone who will promote their interpretation of the facts and issues. The workers' compensation board (WCB) has issued various policy statements as to what constitutes the elements necessary before a formal hearing can be
scheduled. In short form, the preliminary elements required are the filing of a formal written claim known as a c-3. The filing of medical reports most commonly known as a c-4 with an opinion from the health provider alleging that the condition presented was caused by a work situation and the filing by the employer usually by submitting a form known as a c-2 containing the employers' information, if any, about the claim . This should be followed by a formal employer position document or response in the form of a c-6, c-7 or c-9. Not all claims require continued involvement by "a trier of fact" unless a dispute over the compensability of the claim or further treatment is questioned. Employers and their insurance carriers may make voluntary payments regardless but, the claimants rights are not formally protected by the full scope of the Workers' Compensation Law (WCL) until formally established by a written finding known as a decision of the WCB. In cases where continuing claims are presented; the case is set for presentation of the claim subject to the Workers' Compensation Law (WCL) as well as the rules and regulations of the WCB.

As stated in this blog previously, a full and complete discussion regarding a specific case or your rights concerning a specific fact pattern should be conducted in person with a representative so that it can be fully evaluated. This blogg is merely presented as general information and can not be considered a formal legal opinion on any specific case.


Can I settle my Compensation Case?

Generally yes but; the Workers' Compensation Law prohibits any agreement to release a claimant's rights under the New York State Workers' Compensation Law ( WCL) unless approved by court order, (i.e., a decision of the Workers' Compensation Board.) Therefore, any
agreement concerning the nature and scope as well as benefits available or applicable emanating from a job related injury, occupational disease etc, written or otherwise, between an employer or their insurance company and an individual worker whether disabled or not, without formal acceptance through a written decision of the Workers' Compensation Board is ineffective, illegal and can not be enforced. The Compensation Law permits settlements known as section 32 Agreements and Wisc settlements. These are formal agreements presented to the Workers' Compensation Board (WCB) which when approved, can
become binding on all parties subject to the specific limitations and rules found in the law. Agreements entered into between individuals and their companies outside of the compensation law may be binding in other forums for example under the terms of a union negotiated benefit or a third party action but will not limit the workers' rights and enforcement under the authority of the WCL until and unless it is approved by the WCB.


What is Workers' Compensation?

Workers' Compensation in New York State is mandatory insurance coverage for most workers. With few exceptions, any worker who is injured, disabled or effected by their work environment is protected by this coverage. Such protection involves medical treatment and
indemnity payments for lost wages. In some cases, in addition to lost time from work, indemnity payments may also apply for permanent limitations known as schedule loss of use with court directed awards for same. In other cases, permanency my entitle such workers to continuing medical payments and treatment with further awards for continuing loss of wages or reduced earnings subject to law changes and applications dependent upon the date of the accident. Rates for losses and limitations are subject to case law, statutory law and their interpretations. It is usually best to consult a lawyer about your specific issue for individual applications that effect your injury or problem.


First Blog for Injured Workers on Long Island

This will be a forum for discussion of Workers' Compensation Issues. We all await oral argument before the New York State Court of Appeals on pressing issues. We are also looking forward to answers to questions that have been caused by the recently issued December 1, 2010 Medical Treatment Guidelines. Possibly, the New York State Legislature
will resolve some of these questions. We expect injured workers with permanent disabilities to have their treament rights protected and will see what the court does on this issue. This will undoubtably effect long island workers, suffolk county residents and all disabled workers. Doctors and treatment by various practitioners including chiropractors, physical therapists and orthopedics have been limited by the present position of the Workers' Compensation Board and its many recent decisons. Hopefully there will be an end to speculation. We would all like to know , that condions and agreements entered into before the recent changes to the Medical Treatment Guideline are not eliminated or changed by permitting a retroactive application of the new Guidelines.
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WE REPRESENT WORKERS - Workers Compensation and social security disability

Eliot S. Levine & Associates
Attorneys at Law
Litigation attorney handling New York State Workers’ Compensation and Social Security Disability cases since 1978

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Contact Eliot S. Levine & Associates

Eliot S. Levine & Associates
Attorneys at Law

1455 Veterans Highway

Hauppauge, New York  11749

Telephone: (631) 234-5484
Fax: (631) 234-
5561
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Q: Am I entitled to the Zadroga 9/11 Bill??

A: If you had WTC Exposure with Occupational Injuries or Occupational Diseases from on the job exposure. 
 
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Q: I was hurt at work…. What do I do??

A: File a Claim …C-3 form, with the Workers’ Compensation Board.

Q: I was in the Hospital …. What do I do??
A: File a C-4 report with the Workers’ Compensation Board.

Q: I went to the Doctor …. Do I have to pay the doctor?
A: NO, make sure you give a complete work history of the accident and they file a C-4 report.

Q: I’m not getting paid any $ from my job…. How do I get $ ??
A: File a Claim…C-3 form, with the Workers’ Compensation Board.

Q: I already applied for Workers’ Compensation:
Q: I have a hearing date…. What do I do? ….

A: Get copies of all doctors’ C-4 reports and bring them to the hearing.

Q: Do I need an attorney or can I do it myself ??
A: You can appear without an attorney, BUT it is best if you are represented since the employer will have their insurance companies attorney at the hearing.

Q: I had a hearing and I did NOT get any $. Why not ??
A: There could be many reasons, such as:
1. your employer is fighting the case or
2. you do not have proper medical reports.


Q: I lost my job (because I was out of work due to my injury at work) Can they do this ?
A: YES, New York does NOT protect your job if you are out of work because of an injury. You may be protected if you are part of a union negotiated contract.

Q: Who do I have to tell I was injured at work ??
A: Your Doctors, Your Supervisor at work, the Workers’ Compensation Board.

 

Eliot Levine and Associates
(800) 619-5454
Fax: (631) 234-5561
www.Redsail2.com

 
     

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Garden City, NY 11530
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Hauppauge, NY 11749
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Shirley, NY 11967
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