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

Case No. 2022 NY Slip Op 06850 [212 AD3d 126]
Regular Panel Decision
Dec 01, 2022

Matter of Levi v. New York State Workers' Compensation Bd.

Petitioner, a licensed chiropractor, was removed from the list of authorized medical providers by the New York State Workers' Compensation Board after an investigation revealed he received unlawful payments from a durable medical equipment (DME) supplier, Elite Medical Supply of New York, LLC. This was deemed a violation of Workers' Compensation Law §§ 13-d (2) (g), 13-l (10) (g) and 8 NYCRR 29.1 (b) (3). Petitioner challenged this removal via a CPLR article 78 proceeding, asserting a statutory right to a hearing before the Chiropractic Practice Committee (CPC) prior to removal. The Supreme Court dismissed the petition, and the Appellate Division, Third Department, affirmed. The appellate court held that while Workers' Compensation Law § 13-l (10) outlines a CPC hearing process, the Chair of the Workers' Compensation Board also possesses independent authority under Workers' Compensation Law §§ 13-l (12) and 13-d (1) to investigate and remove a provider without a hearing when the underlying facts, such as petitioner's admitted receipt of unlawful payments, are undisputed and do not present questions of fact.

ChiropractorMedical ProviderAuthorization RemovalUnlawful PaymentsDurable Medical EquipmentWorkers' Compensation BoardProfessional MisconductDue ProcessAdministrative LawCPLR Article 78
References
4
Case No. MISSING
Regular Panel Decision

Claim of Schell v. Right

A claimant was injured in April 1993, establishing accident, notice, and causal relationship. Compensation was stipulated at $225 per week for physical disability. Later, a consequential psychiatric condition was affirmed, setting a higher payment rate of $358.73 per week from 1994. The workers' compensation carrier failed to pay this higher rate retroactively after the August 9, 2000 determination. A Workers' Compensation Law Judge imposed a penalty under Workers’ Compensation Law § 25 (3) (f) for this failure, but the Workers’ Compensation Board rescinded it due to a lack of sufficient evidence. The claimant appealed, arguing that the penalty provisions are self-executing and mandatory for late payments. The appellate court reversed the Board's decision, finding no substantial evidence to support the rescission, and remitted the matter for further proceedings, emphasizing the mandatory nature of the penalty for delayed award payments.

Workers' CompensationPenalty AssessmentLate PaymentRetroactive BenefitsPsychiatric DisabilityCarrier LiabilityMandatory PenaltyBoard ReversalAppellate ReviewRemand
References
3
Case No. MISSING
Regular Panel Decision
Aug 01, 2002

Claim of Petitt v. Eaton & Van Winkle

The claimant was injured in a 1993 elevator accident but did not file a workers' compensation claim until 1999. The Workers' Compensation Board dismissed the claim as time-barred under Workers' Compensation Law § 28, which mandates dismissal if a claim is not filed within two years of the accident. On appeal, the claimant argued the employer and carrier waived the § 28 defense by failing to timely raise it and by making advance payments. The Board found the defense was timely raised at the first hearing and determined that the employer's one-day wage payment was sick leave, not an advance payment of compensation. The appellate court affirmed the Board's decision, concluding that the Board's findings were supported by substantial evidence.

Workers' CompensationStatute of LimitationsTime-Barred ClaimWaiver DefenseAdvance Payment of CompensationSick Leave PolicyAppellate ReviewBoard DecisionElevator Accident
References
5
Case No. MISSING
Regular Panel Decision

Claim of Joslin v. City of Albany Fire Department

The claimant appealed a Workers’ Compensation Board decision regarding the method of payment for his hearing loss benefits, specifically challenging the biweekly installment plan. The claimant argued that Workers’ Compensation Law § 49-bb, which governs occupational loss of hearing claims, mandated a different payment method. The court rejected this contention, asserting that Workers’ Compensation Law § 15 (3) (m), which covers schedule awards for hearing losses generally, and § 49-cc, which directs occupational loss of hearing compensation to align with § 15 (3), govern the payment. Consequently, the court affirmed that the claimant was entitled to biweekly scheduled payments, consistent with other schedule loss awards.

Hearing lossWorkers' CompensationOccupational diseaseSchedule awardBiweekly paymentsStatutory interpretationAppealCompensation benefitsWorkers' Compensation Board
References
2
Case No. 2018 NY Slip Op 08227
Regular Panel Decision
Nov 29, 2018

Matter of Kelly v. New York State Workers' Compensation Bd.

In 2006, claimant Grace Kelly established a workers' compensation claim for an occupational disease. The State Insurance Fund (SIF) repeatedly sought to transfer liability to the Special Fund for Reopened Cases, which was denied by Workers' Compensation Law Judges. The Workers' Compensation Board affirmed these denials and assessed $500 penalties against both SIF and its counsel, Walsh and Hacker, for filing an application for review without reasonable grounds. Walsh and Hacker appealed the penalty imposed against them to the Appellate Division, Third Department. The Appellate Division found insufficient evidence to support the Board's finding that Walsh and Hacker's application lacked reasonable grounds, and therefore reversed the penalty against them, modifying and affirming the Board's decision.

PenaltiesAppellate ReviewSpecial Fund for Reopened CasesWorkers' Compensation Law § 25-aWorkers' Compensation Law § 114-aAttorney SanctionsAdministrative LawBoard DecisionJudiciary Law § 431
References
4
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 Marchese v. New York State Department of Correctional Services

Claimant, injured in October 1997, initially received full wages from their employer, then workers' compensation benefits after employment termination. Following an award of benefits in February 2000, a dispute arose regarding the payment of claimant's counsel fee. The Workers’ Compensation Board ruled that the fee should be paid in installments from continuing payments to the claimant, rather than from the portion reimbursing the employer. Claimant appealed this decision, arguing that continuing payments were subject to adjustment and thus not an award of compensation. The Appellate Division affirmed the Board's decision, emphasizing the Board's broad discretion under Workers’ Compensation Law § 24 and finding no unfairness in the payment method, as the award was sufficient to cover both employer reimbursement and the attorneys' lien.

Attorney FeesWorkers' Compensation LawLien on CompensationContinuing PaymentsBoard DiscretionAppellate ReviewEmployer ReimbursementAward Payment MethodStatutory InterpretationCounsel Fee
References
2
Case No. MISSING
Regular Panel Decision
Jun 20, 1986

Claim of Foglia v. New York City Housing Authority

The claimant, a New York City Housing Authority police officer, sustained a compensable knee injury in 1974. The case was reopened in 1983 due to increased disability, and the Special Fund for Reopened Cases was put on notice for potential liability under Workers' Compensation Law § 25-a. The issue was whether there was an advance payment of compensation, which would relieve the Special Fund from liability. The claimant testified that he retired in 1983 but had been on limited duty performing clerical work at full salary since 1982 due to his injury. The Workers' Compensation Board determined that these full salary payments for lighter work constituted an advance payment of compensation. The court affirmed the Board's decision, finding substantial evidence to support the determination that an advance payment of compensation relieved the Special Fund from liability.

Workers' Compensation BoardAdvance PaymentSpecial FundReopened CasesDisabilitySchedule LossPolice OfficerLimited DutySubstantial EvidenceFactual Determination
References
2
Case No. MISSING
Regular Panel Decision

Matter of Covert v. Niagara County

Claimant, a public assistance recipient, suffered a work-related injury while assigned to Niagara County through a work experience program. A Workers’ Compensation Law Judge initially established the claim and determined an average weekly wage based on public assistance benefits. After public assistance benefits were suspended, the claimant sought lost wage benefits. The Workers’ Compensation Board affirmed a WCLJ decision, ruling that payments made under the work experience program constituted "wages" under the Workers’ Compensation Law. Niagara County and its third-party administrator appealed this decision. The appellate court dismissed the appeal, holding that the Board's decision was interlocutory and did not dispose of all substantive issues, thus precluding immediate appeal. The court noted that review could be sought if and when a final determination on wage replacement benefits is issued.

Wage DeterminationPublic Assistance BenefitsWork Experience ProgramInterlocutory AppealAppellate JurisdictionMedical Evidence SufficiencySchedule Loss of UseLost Wage ClaimWorkers' Compensation Board ReviewFinality of Decision
References
9
Case No. MISSING
Regular Panel Decision

Claim of Robinson v. Holiday Showcase Restaurants, Inc.

Claimant sustained a left knee injury in 1995, later including reflex sympathetic dystrophy (RSD). Indemnity benefits were settled in 2002 with a $27,000 lump-sum payment, with the employer's carrier retaining liability for medical treatment. In 2005, the carrier sought to transfer medical liability to the Special Fund for Reopened Cases under Workers’ Compensation Law § 25-a. The Workers’ Compensation Board denied this, ruling that the three-year lapse period from the last compensation payment had not passed, as the lump-sum settlement was allocated to extend benefits until December 31, 2008, under Workers’ Compensation Law § 25-a (7). This appellate court affirmed the Board's decision, rejecting the carrier's argument that § 25-a (7) applies only to nonschedule adjustment settlements and found no basis to disturb the Board's conclusion.

Workers' CompensationSpecial Fund for Reopened CasesLump Sum SettlementMedical LiabilityIndemnity BenefitsReflex Sympathetic DystrophyStatutory InterpretationAppellate Review
References
2
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