Workers’ Compensation Carrier Not Liable After Liability Has Shifted to Special Fund—Board Overruled Precedent Holding Otherwise When the Carrier is Responsible for Delay Until the Special Fund Is Available to Assume Liability

The Third Department upheld the Workers’ Compensation Board’s determination that the workers’ compensation carrier is not liable for medical expenses after liability has been shifted to the Special Fund. The Board had the power to overrule prior precedent which allowed the carrier to remain liable if it was attempting to delay providing benefits in order to have liability shifted to the Special Fund:

Workers’ Compensation Law § 25-a (1) provides that, where seven years have passed from the date of claimant’s injury and three years have passed from the date of the last payment of compensation, “if an award is made it shall be against the [S]pecial [F]und” (emphasis added). Both of those time periods have undoubtedly been met in this case. The Board has previously observed, however, that a carrier with a pending application to shift liability may be tempted to delay in approving necessary medical expenses in order to avoid the complications of paying for them and later seeking reimbursement from the Special Fund. In an effort to address that concern, the Board had held that, in certain instances, a carrier would be held liable for medical expenses that would otherwise be the responsibility of the Special Fund if it “had attempted to delay payment for the surgery until after a determination was made regarding the applicability of [Workers’ Compensation Law] § 25-a, and not based . . . on a good faith objection to the surgery” … .

In the decision at issue here, the Board discussed that precedent at length and overruled it, which it was free to do given that it “set forth its reasons for doing so” and considered appropriate statutory and judicial authorities … . * * *

“The purpose of [Workers’ Compensation Law § ] 25-a is to save employers and insurance carriers from liability . . . for stale claims of injured employees” … . Workers’ Compensation Law § 25-a (1) furthers that purpose by requiring that any award “shall be [made] against the [S]pecial [F]und” if the requisite time periods have elapsed (emphasis added). As both the language and purpose of the statute demonstrate, the carrier “has no further interest in [the] payment of the claim” once liability has shifted to the Special Fund … , and “the Board ha[s] no power to direct that the award be paid by the [carrier] instead of out of the [S]pecial [F]und” under those circumstances … . Thus, the Board properly concluded that the statute does not permit a carrier to be held liable for medical expenses incurred after liability has been shifted to the Special Fund. Matter of Ercole v New York State Police, 2014 NY Slip Op 04550, 3rd Dept 6-19-14