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FAILURE TO INFORM CARRIER OF LAWN CARE WORK WARRANTED RETURN OF BENEFITS PAID, BUT NOT A PERMANENT BAR ON FUTURE BENEFITS.

The Third Department upheld the board’s determination that claimant knowingly failed to inform the carrier he was doing some lawn care work while collecting workers’ compensation benefits. The omission was deemed a knowing false statement or misrepresentation warranting return of the benefits paid. However, the board’s ruling claimant was permanently barred from seeking benefits was not warranted by the facts:

… [A]n omission of material information may constitute a knowing false statement or misrepresentation … . We thus find that substantial evidence supports the Board’s credibility determination that claimant’s failure to fully describe and disclose his lawn mowing activities to the carrier and the carrier’s consultant at the time of the medical examination constituted knowing false statements to obtain workers’ compensation benefits in violation of Workers’ Compensation Law § 114-a (1) … .

We reach a different conclusion as to the Board’s determination permanently disqualifying claimant from receiving any future wage replacement benefits. The applicable standard is that the penalty imposed may not be disproportionate to the underlying misconduct … . In cases where this very significant sanction has been approved, the underlying deception has been deemed “egregious” or severe, or there was a lack of mitigating circumstances … . Here, the Board provided no rationale supporting its determination that this onerous penalty was warranted, and we find inadequate support for such a finding upon review. Matter of Kodra v Mondelez Intl., Inc., 2016 NY Slip Op 08136, 3rd Dept 12-1-16

 

WORKER’S COMPENSATION LAW (FAILURE TO INFORM CARRIER OF LAWN CARE WORK WARRANTED RETURN OF BENEFITS PAID, BUT NOT A PERMANENT BAR ON FUTURE BENEFITS)

SPECIAL DISABILITY FUND CAN BE COMPELLED BY COURT ORDER TO CONSENT, NUNC PRO TUNC, TO A THIRD-PARTY SETTLEMENT.

The Court of Appeals, reversing Supreme Court, determined the Workers’ Compensation carrier could seek a court order compelling the Special Disability Fund to consent to a settlement with a third-party.  Here the carrier agreed to the settlement and the carrier then sought retroactive consent from the Special Disability Fund, which refused:

Here, as required by section 29, the injured employee sought and obtained Ace Fire’s approval prior to entering the settlement of the third-party action. Ace Fire, however, did not seek the Special Disability Fund’s written approval prior to settlement. When Ace Fire sought the Special Disability Fund’s retroactive consent, the Fund refused, asserting that Ace Fire had forfeited its right to reimbursement. Ace Fire then commenced this proceeding asking Supreme Court to compel the Special Disability Fund’s consent nunc pro tunc under Workers’ Compensation Law § 29 (5).

We have repeatedly recognized “that a statute . . . must be construed as a whole and that its various sections must be considered together and with reference to each other” … . The language in section 29 (1) establishing what entities may be deemed lienors is essentially identical to the language in section 29 (5) referring to the entities whose consent to settlement is required and, if not obtained, can be compelled upon application to the court — i.e., the “person, association, corporation, or insurance carrier liable to pay” compensation benefits. Here, the parties do not dispute that the consent of the Special Disability Fund to settlement of the employee’s third party action was required. Thus, assuming, for purposes of this appeal, that the Special Disability Fund is a lienor whose consent to settlement is required under Workers’ Compensation Law § 29 (1), we conclude that the carrier may seek to obtain the Fund’s consent from Supreme Court nunc pro tunc under section 29 (5). There is no principled basis for concluding that the Special Disability Fund’s consent is required as a lienor under one portion of the statute, but that the failure to obtain it cannot be cured, as it can for other lienors, under the same statute. Ace Fire Underwriters Ins. Co. v Special Funds Conservation Comm., 2016 NY Slip Op 07833, CtApp 11-22-16

 

WORKERS’ COMPENSATION LAW (SPECIAL DISABILITY FUND CAN BE COMPELLED BY COURT ORDER TO CONSENT, NUNC PRO TUNC, TO A THIRD-PARTY SETTLEMENT)/SPECIAL DISABILITY FUND (WORKERS’ COMPENSATION LAW, SPECIAL DISABILITY FUND CAN BE COMPELLED BY COURT ORDER TO CONSENT, NUNC PRO TUNC, TO A THIRD-PARTY SETTLEMENT)

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IN A CITY WHICH DOES NOT PROVIDE WORKERS’ COMPENSATION BENEFITS FOR ITS POLICE OFFICERS, AN OFFICER RECEIVING BENEFITS PURSUANT TO GENERAL MUNICIPAL LAW 207-c IS NOT BARRED FROM SUING FOR GENERAL MUNICIPAL LAW 205-e BENEFITS.

The Court of Appeals, in a full-fledged opinion by Judge Stein, over a dissent, reversing the Appellate Division, determined a police officer who receives benefits under General Municipal Law 207-c is not barred from suing for benefits under General Municipal Law 205-e in a city which does not provide workers’ compensation benefits. The officer her alleged asbestos-related injury caused by the building which housed the police station:

“In addition to any other right of action or recovery under any other provision of law,” section 205-e permits police officers to bring tort claims for injuries sustained “while in the discharge or performance at any time or place of any duty imposed by . . . superior officers” where such injuries occur “directly or indirectly as a result of any neglect, omission, willful or culpable negligence of any person or persons in failing to comply with the requirements of any of the statutes, ordinances, rules, orders and requirements of the federal, state, county, village, town or city governments” (General Municipal Law § 205-e [1]). Separately, section 207-c “provides for the payment of the full amount of regular salary or wages,” along with payment for medical treatment and hospital care, “to a police officer or other covered municipal employee who is injured ‘in the performance of his [or her] duties’ or is taken ill ‘as a result of the performance of [such] duties'” * * *

… [W]e reject the City’s argument, also adopted by the dissent, that General Municipal Law § 207-c benefits can be equated to workers’ compensation benefits for purposes of interpreting the proviso contained in General Municipal Law § 205-e [FN2]. The language of section 205-e prohibits only recipients of workers’ compensation benefits from commencing suit against their employers; it does not, by its terms, bar the commencement of suits by recipients of section 207-c benefits — which we have repeatedly recognized to be separate and distinct from workers’ compensation benefits. In fact, section 205-e states that the right contained therein is “[i]n addition to any other right of action or recovery under any other provision of law” (General Municipal Law § 205-e [1]). Matter of Diegelman v City of Buffalo, 2016 NY Slip Op 07817, CtApp 11-21-16

 

MUNICIPAL LAW (IN A CITY WHICH DOES NOT PROVIDE WORKERS’ COMPENSATION BENEFITS FOR ITS POLICE OFFICERS, AN OFFICER RECEIVING BENEFITS PURSUANT TO GENERAL MUNICIPAL LAW 207-c IS NOT BARRED FROM SUING FOR GENERAL MUNICIPAL LAW 205-e BENEFITS)/POLICE OFFICERS (IN A CITY WHICH DOES NOT PROVIDE WORKERS’ COMPENSATION BENEFITS FOR ITS POLICE OFFICERS, AN OFFICER RECEIVING BENEFITS PURSUANT TO GENERAL MUNICIPAL LAW 207-c IS NOT BARRED FROM SUING FOR GENERAL MUNICIPAL LAW 205-e BENEFITS)/GENERAL MUNICIPAL LAW IN A CITY WHICH DOES NOT PROVIDE WORKERS’ COMPENSATION BENEFITS FOR ITS POLICE OFFICERS, AN OFFICER RECEIVING BENEFITS PURSUANT TO GENERAL MUNICIPAL LAW 207-c IS NOT BARRED FROM SUING FOR GENERAL MUNICIPAL LAW 205-e BENEFITS)/WORKERS COMPENSATION LAW (IN A CITY WHICH DOES NOT PROVIDE WORKERS’ COMPENSATION BENEFITS FOR ITS POLICE OFFICERS, AN OFFICER RECEIVING BENEFITS PURSUANT TO GENERAL MUNICIPAL LAW 207-c IS NOT BARRED FROM SUING FOR GENERAL MUNICIPAL LAW 205-e BENEFITS)

CLAIMANT PRECLUDED FROM FURTHER WORKERS’ COMPENSATION BENEFITS FOR FAILURE TO SEEK PERMISSION BEFORE SETTLING A RELATED TORT ACTION, MEANING OF THIRD PARTY ACTION IN THIS CONTEXT EXPLAINED.

The Third Department determined claimant did not seek permission from her Workers’ Compensation carrier before settling another action which arose from the some of the same allegations as her Workers’ Compensation claim. Therefore she was precluded from receiving future Workers’ Compensation benefits. Claimant unsuccessfully argued that the federal court action which settled was not a “third party” action within the meaning of the Workers’ Compensation Law because the action was against claimant’s co-worker and employer, not a “third party:”

“Workers’ Compensation Law § 29 (5) requires either the carrier’s consent or a compromise order from the court in which the third-party action is pending for a claimant to settle a third-party action and continue receiving compensation benefits” … . Claimant urges that her federal lawsuit was not a third-party action since the statute addresses “the negligence or wrong of another not in the same employ” (Workers’ Compensation Law § 29 [1]) and the associate dean who harassed her had the same employer as her. The Court of Appeals, however, has recently reiterated that Workers’ Compensation Law § 29, “‘read in its entirety and in context, clearly reveals a legislative design to provide for reimbursement of the compensation carrier whenever a recovery is obtained in tort for the same injury that was a predicate for the payment of compensation benefits'” … . “The Court reasoned that “‘[i]t would be unreasonable to read the statute as mandating a different result merely because the recovery came out of the pockets of a coemployee [or the employer] and not from the resources of a stranger'” … . Matter of Shiner v SUNY At Buffalo, 2016 NY Slip Op 07738, 3rd Dept 11-17-16

WORKERS’ COMPENSATION LAW (CLAIMANT PRECLUDED FROM FURTHER WORKERS’ COMPENSATION BENEFITS FOR FAILURE TO SEEK PERMISSION BEFORE SETTLING A RELATED TORT ACTION, MEANING OF THIRD PARTY ACTION IN THIS CONTEXT EXPLAINED)

NONWORKING CLAIMANT SUBJECT TO THE 75% CAP ON WAGE-EARNING CAPACITY IS NOT AUTOMATICALLY ENTITLED TO NO LESS THAN 25% LOSS OF WAGE- EARNING CAPACITY FOR PURPOSES OF DETERMINING THE DURATION OF BENEFITS; HERE A 15% LOSS OF WAGE-EARNING CAPACITY UPHELD.

The Third Department rejected the argument by the permanently disabled claimant that, because of a conflict between two applicable statutes, she could not be deemed to have sustained anything less than a 25% loss of wage-earning capacity. The Third Department determined the two statutory provisions were not in conflict and the evidence supported a 15% loss of wage-earning capacity:

Claimant argues that, because Workers’ Compensation Law § 15 (5-a) limited her wage-earning capacity as a nonworking claimant to no more than 75% of her “former full time actual earnings,” the Board was statutorily prohibited from determining that she had less than a 25% loss of wage-earning capacity under Workers’ Compensation Law § 15 (3) (w). She asserts that Workers’ Compensation Law § 15 (3) (w) (xi) and (xii) are in conflict with Workers’ Compensation Law § 15 (5-a) and that, to reconcile this perceived conflict, we should construe these provisions as applying only to claimants who are employed at the time of classification — i.e., those claimants who are not subject to the 75% restriction imposed by Workers’ Compensation Law § 15 (5-a). * * *

As relevant here, in cases of permanent partial disability that are not amenable to schedule awards, “wage-earning capacity” is used to determine a claimant’s weekly rate of compensation. Specifically, in such cases, a claimant’s rate of compensation is two thirds of the difference between his or her average weekly wage and his or her wage-earning capacity (see Workers’ Compensation Law § 15 [3] [w]). Where a claimant is unemployed, wage-earning capacity is fixed by the Board — subject to a 75% cap (see Workers’ Compensation Law § 15 [5-a]). In contrast, “loss of wage-earning capacity,” a term that was added in 2007 as part of a comprehensive reform of the Workers’ Compensation Law (see L 2007, ch 6, § 4), is used at the time of classification to set the maximum number of weeks over which a claimant with a permanent partial disability is entitled to receive benefits (see Workers’ Compensation Law § 15 [3] [w]). For instance, where, as here, a claimant is found to have sustained a 15% loss of wage-earning capacity, he or she is entitled to receive benefits for 225 weeks (see Workers’ Compensation Law § 15 [3] [w] [xii]). Matter of Till v Apex Rehabilitation, 2016 NY Slip Op 07247, 3rd Dept 11-3-16

 

WORKERS’ COMPENSATION LAW (NONWORKING CLAIMANT SUBJECT TO THE 75% CAP ON WAGE-EARNING CAPACITY IS NOT AUTOMATICALLY ENTITLED TO NO LESS THAN 25% LOSS OF WAGE- EARNING CAPACITY FOR PURPOSES OF DETERMINING THE DURATION OF BENEFITS)

VOCATIONAL FACTORS PROPERLY CONSIDERED IN SETTING COMPENSTATION FOR PERMANENTLY DISABLED LABORER.

The Third Department determined the Workers’ Compensation Board properly took into account the claimant’s “vocational factors,” i.e., limited education, language barrier, work history, when setting the appropriate compensation. Claimant suffered a permanent partial disability and had been employed as a landscaper:

Here, … claimant suffered a permanent partial disability, there is no expectation that he will ever return to his former or similar employment as a laborer, and the Board necessarily considered vocational factors when it established his loss of wage-earning capacity. Because the evidence established that claimant did not earn actual wages, the statute authorized the Board to “[fix] in the interest of justice . . . such wage[-]earning capacity as shall be reasonable . . . having due regard to the nature of his injury and his physical impairment” (Workers’ Compensation Law § 15 [5-a]). … [W]e find that the [statute’s] broad discretionary language authorized the Board to consider vocational factors that reflected claimant’s true ability to secure employment, particularly in the absence of evidence to negate claimant’s testimony that his injury contributed to his loss of wage-earning capacity … . Consequently, under the circumstances presented, we perceive no error in the Board’s determination to fix claimant’s wage-earning capacity based on the undisputed evidence of his physical disability and loss of wage-earning capacity resulting from his functional limitations and vocational impediments … . Matter of Rosales v Eugene J. Felice Landscaping, 2016 NY Slip Op 07239, 2nd Dept 11-3-16

WORKERS’ COMPENSATION LAW (VOCATIONAL FACTORS PROPERLY CONSIDERED IN SETTING COMPENSTATION FOR PERMANENTLY DISABLED LABORER)

CLAIMANT DID NOT DEMONSTRATE SUFFICIENT ATTEMPTS TO RETURN TO WORK TO WARRANT BENEFITS; TOTAL INDUSTRIAL DISABILITY CLAIM SENT BACK, JUDGE AND BOARD FAILED TO DISCUSS THE RELEVANT FACTORS IN THE DENIAL OF THAT CLAIM.

The Third Department determined claimant, who was found to have a work-related permanent partial disability, did not demonstrate a sufficient attachment to the labor market to warrant benefits. Claimant’s only attempt to go back to work was enrollment in an unfunded training program. The court sent the “total industrial disability” claim back because the Workers’ Compensation Law Judge and the Board did not cite any medical evidence in support of the denial of the “total industrial disability” claim:

Although the Board has found that a claimant remains attached to the labor market when it is shown that he or she is actively participating in a job location service or a Board-approved vocational rehabilitation … , we find that the Board’s determination here — that by relying solely on an unfunded training program, claimant was not actively participating in vocational rehabilitation and had voluntarily removed himself from the labor market — is supported by substantial evidence and will not be disturbed … .

… [A] “claimant who has a permanent partial disability may nonetheless be classified as totally industrially disabled where the limitations imposed by the work-related disability, coupled with other factors, such as limited educational background and work history, render the claimant incapable of gainful employment” … . While the Board’s determination regarding a total industrial disability will be upheld if supported by substantial evidence ,,, , “Workers’ Compensation Law § 23 requires the Board to include in its decision a statement of facts which formed the basis of its action on the issues raised” … .

Here, the WCLJ found a lack of total industrial disability based solely upon claimant’s failure to seek employment after his accident, with no discussion of the relevant factors relating to a total industrial disability. Matter of Walker v Darcon Constr. Co., 2016 NY Slip Op 05888, 3rd Dept 8-25-16

 

WORKERS’ COMPENSATION LAW (CLAIMANT DID NOT DEMONSTRATE SUFFICIENT ATTEMPTS TO RETURN TO WORK TO WARRANT BENEFITS; TOTAL INDUSTRIAL DISABILITY CLAIM SENT BACK, JUDGE AND BOARD FAILED TO DISCUSS THE RELEVANT FACTORS IN THE DENIAL OF THAT CLAIM)

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LINK BETWEEN HEART ATTACK AND WORK NOT ESTABLISHED BY SUBSTANTIAL EVIDENCE.

The Third Department, reversing the Workers' Compensation Board, found there was insufficient evidence linking claimant's heart attack (myocardial infarction) to his work:

While the Board is entitled to resolve conflicting medical opinions, there must be “medical opinion evidence regarding the probability of a causal relationship supported by a rational basis; a general expression of possibility will not suffice” … . Here, because the testimony of claimant's treating cardiologist expressed merely the possibility that the physical activities in which claimant engaged could have caused his myocardial infarction, such testimony falls short of the required degree of medical proof. As a result, the Board's determination based upon that testimony lacked a rational basis and was not supported by substantial evidence … . Matter of Hartigan v Albany County Sheriff's Dept., 2016 NY Slip Op 04280, 3rd Dept 6-2-16

WORKERS' COMPENSATION (LINK BETWEEN HEART ATTACK AND WORK NOT ESTABLISHED BY SUBSTANTIAL EVIDENCE)/EVIDENCE (WORKERS' COMPENSATION, LINK BETWEEN HEART ATTACK AND WORK NOT ESTABLISHED BY SUBSTANTIAL EVIDENCE)

INJURY IN FALL IN EMPLOYER’S PARKING LAW AROSE FROM EMPLOYMENT.

The Third Department determined injury from a trip and fall in the employer's parking lot was covered under the Workers' Compensation Law:

“To be compensable under the Workers' Compensation Law, an injury must have arisen both out of and in the course of a claimant's employment” … . Moreover, “[w]hile on the employer's premises, going to or coming from work is generally considered an incident of the employment” … .

Here, the record reveals that claimant tripped and fell in the employer's parking lot as she was preparing to leave at the end of her shift. Thus, there is substantial evidence in the record to support the Board's determination that claimant's injury arose out of and in the course of her employment … . Matter of Swartz v Absolut Ctr. for Nursing & Rehab, 2016 NY Slip Op 03937, 3rd Dept 5-19-16

WORKERS' COMPENSATION LAW (INJURY IN FALL IN EMPLOYER'S PARKING LAW AROSE FROM EMPLOYMENT)

STATUTE REQUIRING TIMELY NOTICE OF THE ACCIDENT DID NOT REQUIRE NOTICE OF ALL THE INJURIES STEMMING FROM THE ACCIDENT.

The Third Department determined the statute requiring notice of an accident did not require notice of all the injuries. Here the self-insured employer was timely notified of the accident and claimant's knee injury but was not notified of other injuries stemming from the accident until a year later:

Workers' Compensation Law § 18 provides, in relevant part, that written “[n]otice of an injury . . . for which compensation is payable . . . shall be given to the employer within thirty days after the accident causing the injury.” The same provision also provides that the Board may excuse late notice upon certain grounds, including “that the employer, or his or its agents . . . had knowledge of the accident.” Here, the self-insured employer was provided with notice of the accident and claimant's resulting left knee injury within the statutory 30-day period, but was unaware of claimant's other injuries until nearly a year later when she filed her C-3 claim. The self-insured employer contends that this Court should construe the statutory phrase “had knowledge of the accident” to mean “had knowledge of the injury,” and, as a result, conclude that claimant's late notice for the additional injuries is inexcusable pursuant to Workers' Compensation Law § 18. We reject the self-insured employer's interpretation of Workers' Compensation Law § 18, as it contravenes two foundational rules of statutory construction. Matter of Logan v New York City Health & Hosp. Corp., 2016 NY Slip Op 03776, 3rd Dept 5-12-16

WORKERS' COMPENSATION LAW (STATUTE REQUIRING TIMELY NOTICE OF THE ACCIDENT DID NOT REQUIRE NOTICE OF ALL THE INJURIES STEMMING FROM THE ACCIDENT)

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