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

Case No. 2018 NY Slip Op 05037 [163 AD3d 558]
Regular Panel Decision
Jul 05, 2018

Matter of Empire State Transp. Workers' Compensation Trust v. Special Funds Conservation Comm.

This case concerns a proceeding initiated by Empire State Transportation Workers' Compensation Trust for judicial approval of a settlement, nunc pro tunc, against the Special Funds Conservation Committee. The underlying issue stemmed from the Trust's failure to obtain consent from the Special Funds for a claimant's personal injury settlement, which led the Workers' Compensation Board to find a waiver of reimbursement rights. After an initial denial by the Supreme Court, the Appellate Division reversed and remitted, affirming the court's discretion in compelling such consent. Upon remittitur, the Supreme Court granted the petition, directing the Special Funds to provide nunc pro tunc consent. The Appellate Division affirmed this subsequent order, concluding that the settlement was reasonable, the delay was adequately explained, and no prejudice was demonstrated against the Special Disability Fund.

Workers' CompensationNunc Pro TuncSettlement ApprovalPersonal Injury ActionSpecial Funds Conservation CommitteeAppellate DiscretionReimbursement WaiverJudicial ReviewAppellate PracticeNassau County
References
14
Case No. MISSING
Regular Panel Decision

Claim of Lauritano v. Consolidated Edison Co.

This case involves an appeal from a Workers’ Compensation Board decision regarding the transfer of liability to the Special Fund for Reopened Cases under Workers’ Compensation Law § 25-a. The claimant suffered a work-related heart attack in 1992, received benefits, and the case was closed in 1997. After another heart attack and surgery in 1999, the claim was reopened in 2001. A Workers’ Compensation Law Judge initially found it was not a stale claim, but the Board reversed, transferring liability to the Special Fund. The Special Fund argued that employer payments for lost time in 1999-2000 constituted advance payments of compensation, precluding transfer. However, the court affirmed the Board's determination that these payments, made pursuant to a general sick leave plan, did not qualify as advance payments of compensation under § 25-a, thus supporting the transfer of liability to the Special Fund.

Special Fund for Reopened CasesWorkers' Compensation Law Section 25-aStale Claim DoctrineAdvance Payments of CompensationSick Leave BenefitsLiability TransferHeart Attack InjuryReopened CaseAppellate Review of Board DecisionSubstantial Evidence Standard
References
4
Case No. MISSING
Regular Panel Decision

Claim of Feldman v. Presbyterian Hospital

Claimant sustained a compensable back injury in 1966, leading to a closed case in 1967. The case was reopened in 1980 after claimant experienced additional lost time from work in 1979 and received treatment at the employer's clinic. The primary issue was the liability of the Special Fund for Reopened Cases under Workers’ Compensation Law § 25-a, specifically whether payments made by the employer for clinic visits and sick leave constituted advance payments of compensation. The Workers’ Compensation Board affirmed the discharge of the Special Fund, finding that there was an advance payment and the employer knew the lost time was due to the 1966 injury. On appeal, the court affirmed the Board's decision, holding that the employer's discretionary full reimbursement for clinic visits during working hours, even when sick leave was presumed exhausted, qualified as an advance payment. Therefore, the insurance carrier remained liable as the case was reopened within three years of the last payment.

Workers' CompensationSpecial Fund for Reopened CasesAdvance PaymentEmployer LiabilityMedical TreatmentLost TimeSick LeaveAppellate ReviewWorkers' Compensation Law § 25-aDiscretionary Payments
References
7
Case No. MISSING
Regular Panel Decision
Dec 17, 2004

Claim of Carter v. Von Roll Isola, USA, Inc.

The Workers' Compensation Board ruled that an employer's workers' compensation carrier was entitled to reimbursement from the Special Disability Fund for additional benefits paid due to concurrent employment. The Special Funds Conservation Committee appealed this decision, challenging the Board's interpretation of Workers' Compensation Law § 15 (8) (1). The core issue was whether the notice of the right to reimbursement must be filed before any award or only before the award dealing with concurrent wages. The appellate court affirmed the Board's interpretation, holding that the notice only needs to precede the concurrent wage award, finding this consistent with the statutory text and context. Therefore, the carrier's notice, filed before the concurrent wage award, was deemed timely.

Workers' Compensation LawSpecial Disability FundReimbursementConcurrent EmploymentNotice FilingStatutory InterpretationAppellate DivisionWorkers' Compensation BoardWage CalculationBenefit Awards
References
6
Case No. MISSING
Regular Panel Decision

Matter of Bank v. Village of Tuckahoe

The Workers' Compensation Board ruled that liability for a claimant's left knee injury shifted to the Special Fund for Reopened Cases under Workers' Compensation Law § 25-a. The claimant sustained a work-related injury in June 2005, and compensation benefits were paid until June 20, 2005. In April 2012, a physician requested an MRI, which was performed and revealed a meniscal tear. Subsequently, surgery was authorized and performed in July 2012. The self-insured employer and its third-party administrator sought to shift liability to the Special Fund, a move initially rejected by a Workers' Compensation Law Judge but later approved by the Board. The Special Fund appealed the Board's decision. The appellate court reversed the Board's decision, finding that the case was not "truly closed" after the MRI request was approved. The court held that the case was reopened in April 2012, within the statutory seven-year period from the date of injury, thus precluding the shifting of liability to the Special Fund. The matter was remitted to the Board for further proceedings.

Workers' Compensation Law § 25-aSpecial Fund LiabilityReopened Case DoctrineMedical Treatment AuthorizationCase Closure DeterminationSeven-Year RuleLast Payment of CompensationMeniscal TearMRI AuthorizationSurgery Authorization
References
5
Case No. MISSING
Regular Panel Decision
Oct 06, 2004

Belleville v. Madame Pirie's, Inc.

Claimant sustained a work-related back injury in 1991 and began receiving workers' compensation benefits. After a third-party personal injury action settlement in 1994, the case was closed in October 1998 with no present deficiency for compensation payments. In 2004, the case was reopened due to a possible new causally connected injury. A WCLJ found no compensable lost time from April 1998 to July 2004, authorized medical treatment, and directed the Special Fund for Reopened Cases was responsible. The Workers’ Compensation Board affirmed this decision, finding that the time periods specified in Workers’ Compensation Law § 25-a (8) were met due to the passage of time without compensation payment in a closed case, and no application for deficiency compensation was made upon reopening. The Special Fund appealed, and the Board's decision was affirmed.

Workers' CompensationSpecial FundReopened CasesLiability ShiftWorkers’ Compensation Law § 25-aThird-Party SettlementBack InjuryDeficiency CompensationMedical Treatment
References
7
Case No. 2015 NY Slip Op 01635
Regular Panel Decision
Feb 25, 2015

Empire State Transportation Workers' Compensation Trust v. Special Funds Conservation Committee

The Empire State Transportation Workers' Compensation Trust (the carrier) appealed an order denying its petition for judicial approval of a settlement nunc pro tunc. The claimant, Licinio Marrero, sustained injuries and settled a personal injury action for $100,000 without obtaining the consent of the Special Funds Conservation Committee (SFCC), which is required when SFCC liability is established prior to settlement. The Supreme Court, Nassau County, denied the carrier's request, believing it lacked discretion to compel such consent. The Appellate Division reversed this decision, clarifying that the Supreme Court does have the discretion to issue a nunc pro tunc order compelling consent if certain conditions are met: the delay was not due to the petitioner's fault, the settlement amount was reasonable, and the SFCC was not prejudiced. The case was remitted to the Supreme Court for it to exercise its discretion.

Workers' Compensation LawSpecial Disability FundNunc Pro Tunc OrderSettlement ApprovalReimbursementPersonal Injury ActionAppellate ReviewJudicial DiscretionCarrier's WaiverConsent Requirement
References
6
Case No. MISSING
Regular Panel Decision

Claim of Fuentes v. New York City Housing Authority

This case concerns an appeal by the Special Fund for Reopened Cases from a Workers’ Compensation Board decision dated November 15, 2006. The Board had transferred liability for a claimant's 1998 work-related back injury to the Special Fund, pursuant to Workers’ Compensation Law § 25-a. The Special Fund argued that certain payments made to the claimant in late 2005, between November 30 and December 17, were advance payments of compensation, which would preclude the transfer of liability. However, the Board found that these payments were charged to the claimant's accumulated sick leave and did not constitute advance payments of compensation. The court affirmed the Board's finding, concluding that the sick leave payments did not prevent the transfer of liability to the Special Fund because they were not made voluntarily in recognition of employer liability, and thus, the criteria for transferring liability to the Special Fund were met.

Special Fund for Reopened CasesWorkers' Compensation Law Section 25-aAdvance Payments of CompensationSick Leave PlanLiability TransferStale ClaimApplication to Reopen ClaimWork-Related InjuryBack InjuryTreating Physician Report
References
7
Case No. 524823
Regular Panel Decision
Feb 07, 2019

Matter of Napoli v. Edison

John Napoli, a mechanic, injured both shoulders in a 2003 work accident at the World Trade Center site. He was initially awarded a 20% schedule loss of use (SLU) for each shoulder. In 2012, his condition changed, and liability was transferred to the Special Fund for Reopened Cases. A Workers' Compensation Law Judge (WCLJ) found an additional 45% SLU for each shoulder, but the Workers' Compensation Board reversed this finding after an evaluation by an impartial specialist and crediting an independent medical examiner. The Appellate Division affirmed the Board's decision, concluding that the Board's finding that the additional deterioration in the condition of his shoulders was not causally related to the underlying accident was supported by substantial medical evidence.

Workers' CompensationSchedule Loss of UseShoulder InjuryCausationMedical EvidenceIndependent Medical ExaminationImpartial SpecialistReopened CasesAppellate ReviewSubstantial Evidence
References
11
Case No. MISSING
Regular Panel Decision

De Mayo v. Rensselaer Polytech Institute

The Workers' Compensation Board directed the Special Fund for Reopened Cases to pay a penalty to a claimant under Workers’ Compensation Law § 25 for failing to timely pay an award. The Special Fund appealed this decision, contending that the penalty provision applied only to employers or insurance carriers, not to them. The court, however, disagreed with the Special Fund's interpretation. Citing prior case law, the court held that the Special Fund, once liable for compensation benefits due to the passage of time, stands in the shoes of the carrier regarding the obligation to make timely payments. Therefore, the court affirmed the Board's decision to impose the penalty, emphasizing the legislative policy for prompt compensation payments to injured workers.

Workers' CompensationPenaltyTimely PaymentStatutory InterpretationSpecial FundReopened CasesInsurance CarrierAppellate ReviewStatutory ConstructionLegislative Intent
References
5
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