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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING
Regular Panel Decision

Claim of Surianello v. Consolidated Edison Co. of New York, Inc.

The claimant, an electrical construction mechanic, developed lung disease after working at the World Trade Center (WTC) site. He filed workers' compensation claims, and was eventually found permanently totally disabled. The self-insured employer sought reimbursement from the Special Disability Fund, arguing a preexisting lung condition contributed to the disability. The Workers’ Compensation Board denied reimbursement, concluding the disability was solely caused by WTC site exposure. However, the appellate court reversed, citing medical evidence from pulmonologists Carl Friedman and Neil Schacter, which indicated the claimant's overall disability was materially and substantially greater due to a preexisting restrictive lung disease, not just WTC exposure. The case was remitted to the Board for further proceedings.

WTC Site ExposureOccupational Lung DiseaseSpecial Disability FundReimbursement ClaimPreexisting Medical ConditionPermanent Total DisabilityCausationMedical Expert OpinionAppellate ReviewWorkers' Compensation Board
References
7
Case No. MISSING
Regular Panel Decision

Claim of Zeppieri v. Hofstra University

Claimant, a truck driver with preexisting back and heart problems, suffered a back injury in 2005 and was classified with a permanent partial disability. The employer's workers' compensation carrier sought reimbursement from the Special Disability Fund under Workers' Compensation Law § 15 (8). The Workers' Compensation Board granted this application, and the Fund appealed. The court affirmed the Board's decision, finding that substantial evidence supported the carrier's claim for reimbursement, as medical reports confirmed the claimant's preexisting conditions were permanent, hindered employability, and significantly exacerbated his current disability.

Workers' Compensation LawSpecial Disability FundReimbursementPreexisting ConditionPermanent Partial DisabilityMedical ExaminationEmployabilityAppellate ReviewSubstantial EvidenceBack Injury
References
6
Case No. MISSING
Regular Panel Decision
Mar 31, 1998

Claim of Chadwick v. Mallinkrodt Anesthesia Products

This case involves an appeal by an employer and its insurance carrier from a Workers’ Compensation Board decision, filed March 31, 1998, which discharged the Special Disability Fund from liability under Workers’ Compensation Law § 15 (8). The employer and carrier sought reimbursement, arguing that the claimant's preexisting medical conditions, combined with a work-related injury, resulted in a greater disability. However, the Board found insufficient evidence that these prior conditions hindered the claimant's job potential before the work injury. The Appellate Division, Third Department, affirmed the Board's decision, reiterating that proof of a preexisting permanent impairment hindering job potential is crucial for employer reimbursement under WCL § 15 (8).

Workers' CompensationSpecial Disability FundReimbursementPermanent ImpairmentPreexisting ConditionJob PotentialWorkers' Compensation Law § 15 (8)AppealAffirmed DecisionLiability Discharge
References
3
Case No. MISSING
Regular Panel Decision

Claim of Conway-Acevedo v. Consolidated Edison Co. of N.Y., Inc.

The Workers’ Compensation Board ruled that the employer’s workers’ compensation carrier was not entitled to reimbursement from the Special Disability Fund. The carrier appealed this decision. To establish entitlement to reimbursement, the carrier needed to prove a preexisting permanent impairment that hindered job potential, a subsequent work-related injury, and a permanent disability caused by both conditions that is materially and substantially greater than from the work-related injury alone. The Board found the carrier failed to prove that the claimant’s preexisting osteoarthritis hindered her employment. The appeals court affirmed the Board's decision, citing a lack of evidence that the claimant's arthritic condition caused pain, missed work, or imposed restrictions prior to her workplace accident.

Workers' Compensation BenefitsSpecial Disability FundReimbursement ClaimPreexisting ImpairmentOsteoarthritisWork-Related InjuryPermanent DisabilityEmployer LiabilityCarrier AppealBurden of Proof
References
4
Case No. MISSING
Regular Panel Decision

Claim of Lloyd v. New Era Cap Co.

The claimant, a sewing machine operator, suffered a permanent low back injury in a 2003 workplace fall, leading to an award of workers' compensation benefits. The self-insured employer sought reimbursement from the Special Disability Fund, arguing for apportionment of the disability with a preexisting 1975 gunshot wound. However, the Workers’ Compensation Law Judge and the Board denied this request, finding the claimant to have a permanent total disability solely due to the 2003 accident, thus precluding reimbursement under Workers’ Compensation Law § 15 (8) (d). The appellate court affirmed the Board's decision, emphasizing the Board's authority to reclassify disabilities and its non-binding nature of party stipulations that are not properly approved. The court found substantial evidence supported the Board's determination that the 2003 accident alone caused the permanent total disability.

Workers' CompensationSpecial Disability FundReimbursementPermanent Total DisabilityPreexisting ImpairmentApportionmentMedical EvidenceBoard AuthorityStipulationAppellate Review
References
17
Case No. MISSING
Regular Panel Decision

Claim of Russo v. M & M Transportation

The claimant, employed by M & M Transportation, sustained back and knee injuries in 1976. The employer's insurance carrier sought reimbursement from the Special Disability Fund, alleging various preexisting conditions under Workers’ Compensation Law § 15 (8). However, the carrier failed to produce medical proof to support its claim of preexisting conditions, even after being directed to do so by the Hearing Officer. Consequently, the Hearing Officer discharged the Special Fund, a decision affirmed by the Workers’ Compensation Board. The appellate court affirmed the Board's decision, citing the carrier's failure to provide clarifying medical proof and finding the Board's denial of reconsideration was neither arbitrary nor capricious. The court emphasized that the existence of a previous disability must be established before addressing the employer's knowledge of such a condition.

Workers' CompensationSpecial Disability FundReimbursement ClaimPreexisting Medical ConditionMedical EvidenceCarrier ObligationsBoard DiscretionDenial of ReconsiderationAppellate ReviewSufficiency of Evidence
References
3
Case No. MISSING
Regular Panel Decision
Jan 09, 1991

Claim of Ingham v. Oswego County

The claimant, a nursing assistant for Oswego County, sustained multiple injuries, including to the knee, back, wrist, and head, in an August 1979 accident while assisting a client. Over time, the claimant's condition deteriorated, leading to permanent total disability. A Workers’ Compensation Law Judge initially found a causally related disability for the knee and wrist, later amending it to include the low back and consequential obesity. The self-insured employer, Oswego County, appealed this decision, arguing the back injury claim was untimely and that the disability should be apportioned due to the claimant's prior back history and obesity. The Workers’ Compensation Board affirmed the WCLJ's decision, rejecting the County’s arguments by finding a waiver of the timeliness objection and substantial evidence supporting the aggravation of preexisting conditions as causally related to the 1979 accident, leading to total disability.

Permanent Total DisabilityCausally Related DisabilityAggravation of Preexisting ConditionWaiver of Section 28 DefenseTimeliness of Claim ObjectionConflicting Medical EvidenceSpinal InjuryObesity-Related DisabilityJoint InjuryEmployer Self-Insured
References
3
Case No. 2019 NY Slip Op 05833
Regular Panel Decision
Jul 25, 2019

Matter of Durham v. Wal-Mart Stores, Inc.

Claimant Esther J. Durham suffered work-related injuries, prompting her employer, Wal-Mart Stores, Inc., to seek reimbursement from the Special Disability Fund, alleging preexisting conditions contributing to her disability. A Workers' Compensation Law Judge initially approved the reimbursement claim, but the Workers' Compensation Board later reversed, citing statutory bars on evidence submission and insufficient medical proof from the employer. On appeal, the Appellate Division, Third Department, affirmed the Board's decision. The court agreed that the employer's pretrial conference sheet was inadmissible due to statutory deadlines and that the employer failed to demonstrate a materially and substantially greater disability as required for reimbursement, thereby discharging the Special Disability Fund from liability.

Workers' Compensation ReimbursementSpecial Disability FundPreexisting ImpairmentMaterially and Substantially Greater DisabilityPretrial Conference SheetStatutory Deadline for EvidenceMedical Proof SufficiencyWorkers' Compensation Law § 15(8)(d)Appellate ReviewEmployer Liability
References
9
Case No. MISSING
Regular Panel Decision
Apr 04, 2011

Claim of Stevens v. Hotels

The case concerns an appeal from a Workers' Compensation Board decision that found a workers' compensation carrier's application for reimbursement from the Special Disability Fund to be timely. In 2005, the claimant sustained work-related injuries. The carrier filed a claim for reimbursement in September 2009, based on a medical expert's report acknowledging serious preexisting conditions that significantly increased the claimant's disability. The Special Disability Fund contested the claim's timeliness. The Board ruled the claim was timely, determining that the case was "truly closed" in July 2008, and the C-250 form was filed after reopening and prior to a finding of permanency. The Appellate Division affirmed the Board's decision, concluding that substantial evidence supported the finding that the case was closed in July 2008, thus making the subsequent reimbursement claim timely.

TimelinessReimbursementSpecial Disability FundPreexisting ConditionPermanent Partial DisabilityMaximum Medical ImprovementVocational RehabilitationWorkers' Compensation BenefitsRFA-2 FormC-250 Form
References
4
Case No. MISSING
Regular Panel Decision
Nov 30, 2015

Claim of Gramza v. Buffalo Board of Education

Claimant, a teacher, sustained a work-related injury to his left shoulder and neck in 2005 and was subsequently classified with a permanent partial disability. The employer sought reimbursement from the Special Disability Fund, citing the claimant's preexisting medical conditions, including rheumatoid arthritis and hypertension. The Workers' Compensation Board granted this application, prompting an appeal from the Fund. The court affirmed the Board's decision, finding substantial evidence that the claimant's rheumatoid arthritis was a permanent condition restricting hand use and hindering general employability. An independent medical reviewer's opinion further supported that the claimant's overall disability was significantly greater due to the combined effect of both conditions.

Workers' CompensationSpecial Disability FundReimbursementPreexisting ImpairmentRheumatoid ArthritisPermanent Partial DisabilityMaterially and Substantially Greater DisabilityGeneral EmployabilityIndependent Medical ReviewerAppellate Division
References
6
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