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ALTHOUGH THE ISSUE WAS NOT RAISED BY THE PARTIES, SUPREME COURT SHOULD NOT HAVE DISMISSED PLAINTIFF’S NEGLIGENCE ACTION BEFORE THE WORKERS’ COMPENSATION BOARD RULED ON WHETHER PLAINTIFF WAS INJURED WITHIN THE SCOPE OF HIS EMPLOYMENT (FOURTH DEPT).

The Fourth Department, reversing Supreme Court and reinstating the negligence action, determined Supreme Court did not have jurisdiction over the matter because the Workers’ Compensation Board had not yet ruled whether plaintiff was injured when acting in the scope of his employment. The parties did not raise this issue:

Although not raised by the parties, we conclude that Supreme Court erred in entertaining defendant’s motion. “It is well settled that primary jurisdiction with respect to determinations as to the applicability of the Workers’ Compensation Law has been vested in the Workers’ Compensation Board [(Board)] . . . [I]t is therefore inappropriate for the courts to express views with respect thereto pending determination by’ the Board” … . Whether plaintiff was injured within the scope of his employment “must in the first instance be determined by the [B]oard” … , and the court thus should not have entertained defendant’s motion at this juncture. Rather, the case should have been referred to the Board for a determination of plaintiffs’ eligibility for workers’ compensation benefits … . Warren v E.J. Militello Concrete, Inc., 2019 NY Slip Op 08300, Fourth Dept 11-15-19

 

MEDICAL PROVIDER’S REQUEST FOR A VARIANCE ALLOWING PAYMENT FOR CLAIMANT’S TREATMENT WITH MEDICAL MARIJUANA SHOULD HAVE BEEN CONSIDERED FOR PROSPECTIVE TREATMENT OF CHRONIC PAIN (THIRD DEPT).

The Third Department determined the treating medical provider’s request that the cost of claimant’s treatment with medical marijuana (called a “variance”) be covered by workers’ compensation was properly denied for past treatment but should have been considered for future treatment:

Attached to the August 2017 variance request from claimant’s treating medical provider was a July 2017 medical report in which the provider summarized claimant’s pain management regimen and reviewed the various “beneficial effects of the medical mari[h]uana” that claimant had received. The provider reported, among other things, that claimant’s sleep has improved and pain was reduced “since using medical marihuana,” that medical marihuana “allowed him to participate more with his wife and children” and that he “[e]motionally feels much improved” as a result of using medical marihuana. The treating medical provider also noted that claimant was experiencing a “[f]inancial burden with continuing an optimal dose of the medical THC.”

In our view, the Board properly denied the variance request for medical care but only to the extent such care had already been provided (see 12 NYCRR 324.3 [a] [1]). In an instance such as here, however, where the claimant has a chronic pain condition necessitating ongoing treatment, the Board should have addressed the merits of claimant’s variance request for prospective medical marihuana treatment. Matter of Kluge v Town of Tonawanda, 2019 NY Slip Op 07470, Third Dept 10-17-19

 

METHODS FOR DETERMINING WEEKLY WORKERS’ COMPENSATION BENEFITS FOR SHORT-TERM EMPLOYMENT EXPLAINED, MATTER REMITTED FOR THE GATHERING OF EVIDENCE AND RE-CALCULATION (THIRD DEPT).

The Third Department, reversing the Workers’ Compensation Board, determined the benefits to be provided to the injured worker, based upon only 78 days of employment may have been wrongly calculated and remitted the matter:

Following a hearing, a Workers’ Compensation Law Judge (hereinafter WCLJ) established claimant’s average weekly wage as $933.14, which was arrived at by dividing his total earnings ($12,130.76) by the number of weeks worked (13). The employer and its workers’ compensation carrier (hereinafter collectively referred to as the carrier) sought administrative review. Upon that review, the Workers’ Compensation Board determined that claimant’s average weekly wage should have been calculated pursuant to Workers’ Compensation Law § 14 (3), using a 200 multiplier, and that, so calculated, claimant’s average weekly wage was $598.15. * * *

Under Workers’ Compensation Law § 14 (2), the average annual earnings of a six-day worker is 300 “times the average daily wage or salary . . . which an employee of the same class working substantially the whole of such immediately preceding year in the same or in a similar employment in the same or a neighboring place shall have earned in such employment during the days when so employed.” The carrier did not submit payroll records for similar employees or otherwise assert that such records were unavailable … . In the absence of such information, we cannot determine whether the Board properly rejected the method set forth in Workers’ Compensation Law § 14 (2) before resorting to Workers’ Compensation Law § 14 (3) to calculate claimant’s average weekly wage. Matter of Molina v Icon Parking LLC, 2019 NY Slip Op 07467, Third Dept 10-17-19

 

THE WORKER’S COMPENSATION AWARD SHOULD NOT HAVE BEEN APPORTIONED BETWEEN THE COMPENSABLE INJURY AND A PREEXISTING CONDITION WHICH DID NOT AFFECT CLAIMANT’S ABILITY TO WORK (THIRD DEPT).

The Third Department, reversing the Workers’ Compensation Board, determined the award should not have been apportioned between claimant’s compensable injury and his preexisting MS condition:

As a general rule, apportionment is not applicable as a matter of law where the preexisting condition was not the result of a compensable injury and the claimant was able to effectively perform his or her job duties at the time of the work-related accident despite the preexisting condition” … . “Significantly, degeneration and infirmities which have not previously produced disability are not a proper basis for reduction of compensation” … . …

… [C]laimant’s MS, although not diagnosed until after the work-related accident, was a preexisting condition. There is no evidence whatsoever that claimant’s MS precluded him from performing the duties of his employment. As there is no evidence of an apportionable disability prior to the … accident, apportionment of claimant’s award is, as a matter of law, inappropriate … . Matter of Whitney v Pregis Corp., 2019 NY Slip Op 06828, Third Dept 9-26-19

 

AMENDMENT OF THE WORKERS’ COMPENSATION LAW TO REMOVE THE REQUIREMENT THAT A CLAIMANT DEMONSTRATE ATTACHMENT TO THE LABOR MARKET TO BE ENTITLED TO PERMANENT PARTIAL DISABILITY PAYMENTS DID NOT APPLY RETROACTIVELY TO CLAIMANT (SECOND DEPT).

The Third Department determined claimant was deemed to have involuntarily retired and no longer attached to the labor market in August 2015, well before the amendment of the Workers’ Compensation Law which removed the requirement that a claimant demonstrate attachment to the labor market to be entitled to permanent partial disability payments. The amendment did not apply to claimant retroactively:

… [T]he amendment states, in pertinent part, that in some cases of permanent partial disability, “[c]ompensation . . . shall be payable during the continuance of such permanent partial disability, without the necessity for the claimant who is entitled to benefits at the time of classification to demonstrate ongoing attachment to the labor market” (Workers’ Compensation Law § 15 [3] [w] … ). In sum, the amendment relieves some claimants who have been classified as permanently partially disabled of the burden of having to demonstrate ongoing attachment to the labor market in order to continue to receive wage replacement benefits … . * * *

… [C]laimant was classified as permanently partially disabled in July 2014, and proceedings were conducted before the WCLJ in August 2014 on the issues of claimant’s labor market attachment and voluntary withdrawal. The WLCJ concluded that claimant did not voluntarily retire and was not attached to the labor market, and the Board affirmed the WCLJ’s decision in August 2015. … [T]he Board’s August 2015 decision was issued well before the effective date of the amendment and, as such, this is not a situation in which retroactive application of the amendment is appropriate. Given that the Board declined to apply the amendment retroactively so as to relieve claimant of his obligation to demonstrate ongoing attachment to the labor market in order to continue to receive permanent partial disability benefits, we decline to disturb the Board’s decision. Matter of Pryer v Incorporated Vil. of Hempstead, 2019 NY Slip Op 06561, Third Dept 9-12-19

 

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CLAIMANT PROPERLY DENIED WORKERS’ COMPENSATION BENEFITS BECAUSE CLAIMANT DID NOT OBTAIN THE WORKERS’ COMPENSATION CARRIER’S CONSENT BEFORE SETTLING WITH A THIRD-PARTY (THIRD DEPT).

The Third Department determined the denial of Workers’ Compensation benefits was proper because claimant did not obtain the Workers’ Compensation carriers consent before settling a third-party action arising from the traffic accident:

“Workers’ Compensation Law § 29 (5) requires either the carrier’s consent or a compromise order from the court in which a third-party action is pending for a claimant to settle a third-party action and continue receiving compensation benefits” … . The burden is on the claimant to establish that proper consent was obtained … . “The question of whether a settlement was procured with the proper consent of the carrier is a factual issue for the Board to determine” … . It is “well settled[] that neither [this Court] nor the Court of Appeals has power to upset the determination of an administrative tribunal on a question of fact . . . beyond seeing to it that there is substantial evidence” … .

In support of claimant’s contention that consent for the settlement was properly obtained, he relies on the final sentence in two correspondences sent by the carrier to his third-party counsel stating that the carrier “has no objection to a $50,000 policy limit settlement of the claimant’s bodily injury claim.” Both correspondences, however, also specifically advised that the carrier’s “consent is required prior to settlement or discontinuance of any third-party action” and to “please communicate with [the carrier]” before settlement to arrange for consent and satisfaction of the lien. A review of the entire correspondences and the plain language therein reflects that the carrier anticipated further communication with the third-party counsel prior to consenting to any settlement. Matter of Hisert v Ron Allen Trucking Inc., 2019 NY Slip Op 05735, Third Dept 7-18-19

 

SPECIAL FUND IS LIABLE FOR DEATH BENEFITS WHERE THE CLAIM WAS TRANSFERED TO THE SPECIAL FUND BEFORE THE FUND WAS CLOSED IN 2014 AND THE CLAIMANT DIED AFTER THE FUND WAS CLOSED (THIRD DEPT).

The Third Department, reversing the Workers’ Compensation Board, determined that the Special Fund remained liable for death benefits if the matter had been transferred to the Special Fund before the 2014 closure of the fund. Here the asbestosis case was transferred to the Special Fund in 2011 and the claimant died in 2017:

… [T]he imposition of liability on the Special Fund in this case is not precluded by the statutory amendment [closing the Special Fund], given that liability was transferred to the Special Fund in December 2011, well before the January 1, 2014 closure date. The record does not indicate any violation of the plain language of the statutory sentence at issue. Indeed, the record does not contain a copy of any application by the employer for transfer of liability of a claim to the Special Fund, nor any indication that such an application was filed after January 1, 2014. Thus, the record does not support a finding of a violation of the statute prohibiting the Board from accepting, after the cut-off date, any application by an employer or carrier for transfer of liability of a claim to the Special Fund (see Workers’ Compensation Law § 25-a [1-a]).

This conclusion is supported by our decision in Matter of Misquitta v Getty Petroleum (150 AD3d 1363[2017]), which involved a factual situation similar to that presented here. In Misquitta, the decedent had an established workers’ compensation claim that had been transferred to the Special Fund prior to his death and, after his death, his widow filed a claim for workers’ compensation death benefits. While acknowledging that the consequential death claim was separate and distinct from the decedent’s original claim, this Court ruled that “where . . . liability for a claim has already been transferred from the carrier to the Special Fund and the employee thereafter dies for reasons causally related to the original claim, the Special Fund remains liable for the claim for death benefits” … . Matter of Verneau v Consolidated Edison Co. of N.Y., Inc., 2019 NY Slip Op 05369, Third Dept 7-3-19

 

CLAIMANT HAD THE RIGHT TO CROSS-EXAMINE THE CARRIER’S CONSULTANT, WHO DETERMINED CLAIMANT SUFFERED A 40% SCHEDULE LOSS OF USE, DESPITE THE FACT CLAIMANT NEVER FILED A COMPETING MEDICAL OPINION (THIRD DEPT)

The Third Department determined claimant’s counsel’s request to cross-examine the carrier’s consultant, who concluded claimant suffered a 40% schedule loss of use, should not have been denied on the ground claimant had not filed a competing medical opinion (C-4.3 form):

12 NYCRR 300.10 (c) provides, in relevant part, that “[w]hen the employer or its carrier or special fund desires to produce for cross-examination an attending physician whose report is on file, the referee shall grant an adjournment for such purpose.” As the Board correctly noted, although a claimant’s right to cross-examine a carrier’s consulting physician is not expressly referenced in the cited regulation, it “is permitted under tenets of due process” … . In this regard, a “claimant’s request for cross-examination is not invalidated by the failure to produce a C-4.3 [form]” … , but this right may be waived if not asserted in a timely manner … . Notably, “[t]he only requirement is that the request for such cross-examination must be timely made at a hearing, prior to the WCLJ’s ruling on the merits” … . Matter of Ferguson v Eallonardo Constr., Inc., 2019 NY Slip Op 05255, Third Dept 6-27-19

 

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INFORMATION PROVIDED FOR THE FIRST TIME IN A REPLY TO OPPOSITION TO A SUMMARY JUDGMENT MOTION CAN NOT BE RELIED UPON TO MAKE OUT A PRIMA FACIE CASE, THE APPELLANT’S MOTION FOR SUMMARY JUDGMENT IN THIS ON THE JOB INJURY CASE ON THE GROUND THAT APPELLANT WAS PLAINTIFF’S GENERAL EMPLOYER AND PLAINTIFF’S ONLY REMEDY WAS WORKERS’ COMPENSATION PROPERLY DENIED (SECOND DEPT).

The Second Department determined that information provided for the first time in a reply affidavit could not be relied upon to sustain a movant’s prima facie burden for a summary judgment motion. The plaintiff, who was injured on the job, alleged he was hired by the defendant Bright Star Messenger Service, LLC (hereinafter the appellant). In its motion for summary judgment the appellant alleged it was plaintiff’s general employer and plaintiff’s only remedy was Workers’ Compensation. But included in appellant’s papers was plaintiff’s claim for Worker’s Compensation benefits which listed plaintiff’s employer as “Bright Star Courier.” Therefore the appellant failed to make out a prima facie case that it was plaintiff’s employer. The appellant then submitted a reply affidavit stating that Bright Star Courier had changed its name to Bright Star Messenger Center, LLC prior to the accident:

… Contrary to the appellant’s contention, it failed to make a prima facie showing that it was the plaintiff’s general employer. The appellant submitted the affidavit of a representative of the appellant, who stated that the plaintiff was employed by the appellant on the date of the accident, and that the appellant had procured workers’ compensation insurance for the plaintiff. However, the appellant also submitted Workers’ Compensation Board records showing that the plaintiff had filed a claim for benefits that listed the plaintiff’s employer as “Bright Star Courier.” Under these circumstances, the appellant failed to demonstrate, prima facie, that it was the plaintiff’s general employer … . While the appellant submitted a reply affidavit from its representative averring that Bright Star Courier had changed its name to Bright Star Messenger Center, LLC, prior to the accident, a party cannot sustain its prima facie burden by relying on evidence submitted for the first time in its reply papers  … . The appellant’s failure to make a prima facie showing of its entitlement to judgment as a matter of law required the denial of its motion, regardless of the sufficiency of the plaintiff’s opposition papers … . Matthews v Bright Star Messenger Ctr., LLC, 2019 NY Slip Op 04375, Second Dept 6-5-19

 

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CLAIMANT’S CONVICTION FOR THE UNLAWFUL MANUFACTURE OF METHAMPHETAMINES DID NOT CONSTITUTE PROOF THAT CLAIMANT PERFORMED WORK OR MADE FALSE STATEMENTS REGARDING WORK SUCH THAT CLAIMANT SHOULD BE DISQUALIFIED FROM RECEIVING BENEFITS UPON RELEASE FROM PRISON (THIRD DEPT).

The Third Department determined that claimant’s conviction for the unlawful manufacture of methamphetamine did not constitute work within the meaning of Workers’ Compensation Law 114-a. Therefore, claimant did not perform any work or make any false statements regarding work which would disqualify him from receiving benefits upon release from prison:

Workers’ Compensation Law § 114-a (1) provides, in relevant part, that “[i]f for the purpose of obtaining compensation . . ., or for the purpose of influencing any determination regarding any such payment, a claimant knowingly makes a false statement or representation as to a material fact, such person shall be disqualified from receiving any compensation directly attributable to such false statement or representation.” “In making such a determination, the Board is the sole arbiter of witness credibility and its determination as to whether a claimant violated Workers’ Compensation Law § 114-a will be upheld if supported by substantial evidence” … .

To be guilty of unlawful manufacture of methamphetamine in the third degree, a person must possess, at the same time and location, “[t]wo or more items of laboratory equipment and two or more precursors, chemical reagents or solvents in any combination,” with the intent to use such products to unlawfully manufacture, prepare, or produce methamphetamine, or knowing that another intends to do so (Penal Law § 220.73 [1]). The elements of the crime do not require that any work be performed. Substantial evidence supports the Board’s finding that the conviction alone is insufficient to establish any work activity by claimant or that he received any type of remuneration … . Matter of Stone v Saulsbury/Federal Signal, 2019 NY Slip Op 04250, Third Dept 5-30-19

 

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