At the New York Self-Insurers Association Annual Meeting, Christopher Whyland, Esq. presented on the 2014 workers’ compensation decisions of the Appellate Division, Third Department, heard in Albany, New York. In 2014, the Third Department issued decisions in 85 workers’ compensation cases.
In 2014, the Board was reversed in only nine of the 85 decisions issued by the Third Department and another five appeals were dismissed as interlocutory. In addition, the Court of Appeals affirmed two decisions that involved workers’ compensation decisions.
Some of the case updates included:
Cook v. East Greenbush Police Department (February 13, 2014)
The Case: The claimant worked as a patrol officer. While on duty in January 2009, he was called to the scene of an incident in which an armed suspect was firing shots at passing motorists and law enforcement officers. The claimant and two fellow officers were assigned to be part of the “contact team”, which approached the shooter from behind. With the claimant acting as a spotter, the suspect was shot several times and died from those wounds. The claimant began to miss work on a regular basis in January 2010 and then filed a claim for workers’ compensation benefits, which was refuted by the employer. Thereafter, he was diagnosed with posttraumatic stress disorder related to the January 2009 incident. The presiding Law Judge denied the claim, finding that the events contributing to the claimant’s injury were part of his job description and responsibilities as a police officer. On appeal, the Board affirmed in a split decision. The claimant then repealed.
The Result: The Appellate Division affirmed holding, stating that “the stress must be greater than that which usually occurs in the normal work environment.” Here, although the claimant’s supervisor described the particular circumstances of the encounter as “extraordinary”, the regular course of duty for a police officer requires that he or she be on notice each day that deadly force may be required to subdue a suspect who is endangering public safety.
Islam v. BD Construction & Building (April 10, 2014)
The Case: The claimant in this case (a legal permanent resident) was found to be totally disabled in 2006 as a result of work-related injuries to his head and neck. After this accident, he was convicted of sexual abuse in the first degree and, in 2007, was sentenced to 10 years of probation. In 2009, the claimant was detained in Texas by the U.S. Bureau of Immigration and Customs Enforcement pending a deportation hearing and, due to his failure to provide updated C-4 medical progress reports during his detention, his workers’ compensation benefits were suspended. When he was released from custody in 2011, he immediately returned to New York where he was promptly examined by his physician, who then filed a C-4 indicating that the claimant continued to be totally disabled due to his work-related head and neck injuries. The Board determined that the claimant was entitled to benefits covering the time he spent in detention resulting in this appeal by the carrier.
The Result: The Appellate Division affirmed holding, stating that they cannot agree with the employer’s argument that the claimant’s detention by immigration officials amounts to incarceration upon conviction of a felony, thereby rendering him ineligible to receive work comp benefits. While the claimant was convicted of a felony, his punishment did not include incarceration (he was sentenced to probation). In addition, his confinement for immigration purposes was civil and non-punitive in nature. The board also has the authority to excuse the failure to provide timely progress reports “in the interest of justice.” Here, the claimant submitted C-4 forms indicating treatment prior to and immediately after his immigration detention reflecting continuous symptoms and treatment for his work-related injuries while he was detained.
Hozdic v. TTSI, Inc. (May 29, 2014)
The Case: The claimant injured his lower back while working and successfully applied for workers’ compensation benefits. The carrier disclosed that the claimant had been placed under surveillance and thereafter raised the issue of whether he had violated Workers’ Compensation Law § 114-a. The Board ruled that the claimant knowingly misrepresented his medical condition for the purpose of receiving benefits and, accordingly, found him to be in violation of the law. The Board further assessed a discretionary penalty and permanently disqualified the claimant from receiving wage replacement benefits.
The Result: The Appellate Division affirmed, noting that Workers’ Compensation Law § 114-a (1) disqualifies a claimant who “knowingly makes a false statement or representation as to a material fact…from receiving any compensation directly attributable to such false statement or representation.” Here, the claimant testified that he experienced pain walking, standing and could not lift items weighing more than 10 pounds. His claims were disproven, however, by evidence that he rode his bicycle, took long walks and was observed dragging items like beverage coolers, a barbeque grill and carrying heavy groceries. In light of the evidence that the claimant had knowingly misrepresented his condition in an effort to influence the award of benefits, the Board found that he had violated Workers’ Compensation Law § 114-a.