State News : New York

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NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.  

Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.

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New York


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Employers and carriers were delighted by the Appellate Division’s 2018 decision in Genduso v. New York City Department of Education. That case held that a claimant’s schedule loss of use award would be subject to an automatic deduction for any prior schedule loss of use awards to the same body member. Genduso prevented a claimant from receiving separate schedule loss of use award for separate joints of the same limb. For example, if a claimant received an earlier 15% schedule loss of use of the arm due to an elbow injury two years ago, but later was assessed a 30% SLU of the arm following a shoulder injury, the new 30% SLU would be reduced by the prior 15% arm SLU assigned to the elbow, yielding a net 15% SLU to the arm. The claimant’s bar has challenged this decision in numerous cases over the years and we were concerned that Genduso would be overturned when the Court of Appeals granted certiorari in Johnson v. City of New York and Liuni v. Gander Mountain.

On 4/21/22, the Court of Appeals issued its decision in Johnson v. City of New York and Liuni v. Gander Mountain. This decision does not explicitly overturn Genduso, but it does hold that a claimant may receive separate SLU awards for “different injuries to the same statutory member,” so long as the claimant proves that the second injury, considered by itself, has caused an increase in the claimant’s loss of use. We do not believe that this will be a difficult burden for a claimant who has separate injuries to different joints or parts of the same body member/limb, such as in our elbow/arm example above. The Court asserted in its decision that WCL §15(7) provides that a claimant may receive more than one SLU award in connection with successive injuries to the same body member but that any such award must be limited by “any diminished wage earning capacity due to the previous disability.”

In Johnson, the claimant had bilateral knee injuries in 2006 and then later injured both hips in a 2009 accident. He received schedule awards in the 2009 injury of a 50% SLU of the left leg and a 52.50% SLU of the right leg. After Johnson was awarded these schedules, he reached maximum medical improvement in the 2006 knee injuries. The Law Judge in Johnson found that the claimant had an overall 80% loss of use of the left leg and a 40% loss of use of the right leg. But, given the Genduso decision, the Law Judge reduced the schedule loss of use award by the 50% prior loss of use to the left leg and 40% loss of use to the right leg for the bilateral hip injuries in the 2009 case, leaving the claimant with an “additional” SLU award of 30% for the left left and 0% for the right leg. Both the Board and the Appellate Division affirmed. The Court of Appeals affirmed, citing the absence of evidence in Johnson that would have allowed the Board to determine the loss of use of his legs solely related to his bilateral knee injuries.

The Court also cited support for its decision from Zimmerman v. Akron Falls Park - Erie County, 29 N.Y.2d 815 (1971). Zimmerman involved a claimant who received separate schedule loss of use awards: one for his hand in 1924 for a forearm amputation and a later 1967 injury to his arm for a shoulder injury. The Zimmerman court did not reduce the 1967 schedule award by the 1924 award, noting that the 1924 injury did not affect the 1967 shoulder injury. Accordingly, the court asserted that Zimmerman establishes that offset is not required when the claimant demonstrates that the later injury increases the schedule loss of use of the affected body member beyond the schedule awarded in the earlier injury. In a sharply worded dissent, Judge Wilson argued that the majority’s discussion of Zimmerman was incorrect and wholly unnecessary to their holding. Rather, Judge Wilson felt that Genduso was wrongly decided and that both Johnson and Liuni should have been reversed.

In Liuni, the claimant injured his left elbow in 2007 and received a 22.5% SLU of the left arm for that injury. He later injured his shoulder in 2014. The Workers’ Compensation Law Judge ruled that Liuni had an overall SLU of 50% to the left arm, an increase of 27.5% over schedule loss of use from the 2007 left elbow injury. Liuni’s physician said that the two injuries were separate and not in any way related. The Board and the Appellate Division credited this opinion but noted that under Genduso that the later schedule loss of use award would have to be reduced by the prior schedule loss of use award. The Court of Appeals reversed because there was evidence from Liuni’s expert that the two injuries were separate and distinct pathologies.

In Johnson, the Court of Appeals did not feel that there was sufficient evidence that the two injuries were sufficiently separate from one another because Johnson’s expert testified that his hip and knee injuries were not isolated from one another, leaving open the question of how much loss of use of his legs were related to the knee injuries.

Claims adjusters reviewing cases involving a new injury to a body member for which the claimant received a prior schedule loss of use award will want to consider obtaining an independent medical examination on the question of whether the claimant has experienced any increase in the loss of use above and beyond the previous schedule loss of use award for that same body member. The independent medical examiner will need to state whether any increase in the loss of use is due solely to the new injury or if the increase results from a combination of the new injury and the previous injury (or injuries) to that body member. Similarly, in defending schedule loss of use claims, employers and carriers will want to be sure that attending physicians apply the same standard in addressing schedule loss of use.


Colleen Willis Retires from Partnership


Colleen Willis has retired from her H&W partnership but will maintain "Special Counsel" status with the firm and intends to handle cases from time-to-time after some much needed travel and time with her family.

Law was a second career for Colleen, who graduated from the State University of Buffalo Law School following an 18 year career as a Registered Nurse, working in both hospital and community based settings.

Resident in our Rochester office, Colleen was known as the firm "mom" - making sure not only that our briefs were filed on time but that we remembered to wear a hat before going outside in the winter weather.

She wanted our wonderful clients to know that she enjoyed working with them over the years and that they are "a pretty amazing, smart, and hard working group with challenging jobs." Amen, Colleen - you will be missed by all of us here at Hamberger & Weiss.


Board Enforces Requirement for Certification of RFA-2s


We have learned that the Board will no longer consider RFA-2s that do not have the certification section completed at the bottom of the form. Our clients will recall that the certification section asks whether the person signing the RFA-2 has discussed the issues cited on the RFA-2 with the opposing party or whether that person attempted to contact the opposing party to discuss the issues raised. It appears now that failure to complete this section will result in the Board taking no action on the RFA-2 so please remember to work this requirement into your RFA-2 filing processes.


Appellate Division Extends Taher Rule in New Decision


On 4/14/22, the Appellate Division, Third Department decided Gambardella v. New York City Transit Authority. This decision holds that the Court's previous decisions in Taher v. Yiota Taxi and Arias v. City of New York apply to cases where a claimant is not working and is not receiving indemnity benefits because they have withdrawn from the labor market. As a reminder, Taher and Arias held that claimants may receive both a permanent partial disability classification and schedule loss of use award(s) in the same claim at the same time. For claimants who are working and not receiving lost wage payments at the time of permanency, Taher and Arias allow the claimant to receive a lump-sum schedule loss of use award payment. That award then becomes a credit against any future lost wage benefits flowing from the permanent partial disability classification should they later occur. The Court’s holding in Gambardella shows a willingness to extend the Taher and Arias holdings beyond the original fact patterns in those cases. Gambardella raises the question of whether the Taher / Arias rule will also apply to other fact patterns in which a claimant is not working but also not receiving lost wage payments at the time of permanency.


Reminder - Don't Blindly Split the Difference on SLUs


In recent months we have seen quite a few stipulations, prepared by claimant's counsel and signed by our clients that "split the difference" on SLU opinions, even when both the attending physician and IME have misapplied the guidelines. Our readers may recall that we discussed this in March 2020 when we reminded our readers that the Appellate Division's decision in Parody v. Old Dominion Freight held that the Board is not bound by the medical opinions of schedule loss of use (SLU) in the record and may fashion its own SLU assessment based on the medical evidence and the impairment guidelines if the ultimate result is supported by the record, even if the percentage loss of use awarded has not been given by any medical expert in the record. Thus, a physician's failure to follow the procedure described in the Impairment Guidelines for determining SLU can be used to obtain significant savings on the SLU award in some cases.


Board Announces Changes to C-8.1/C-8.4 Forms


The Board has announced some important updates to the C-8.1 and C-8.4 forms. First, the Board reminded payers completing these forms that only the last four digits of the claimant's Social Security number should be put on the form. The Board determined as of 6/16/21 that it would no longer require the claimant's full nine digit Social Security number on the form.

The Board is also eliminating Part A of the C-8.1 form and publishing a new C-8.1 form on 7/1/22. Payers will be required to use the new form as of 8/15/22. The new C-8.1 form eliminates the objection "Requested treatment is not for an established site or condition," and moves it to a new RFA-2 form that will be published on May 2, 2022. The Board does not comment on the other objection reasons noted on the C-8.1 such as:

  • Withdrawal of authorization based on a conflicting medical report

  • Termination of further medical treatment based on a conflicting medical report

  • Objection to further treatment based on non-appearance at a scheduled IME

  • Denial of authorization based on a medical appliance or program not being covered under the WCL

  • Medical necessity of a requested special service

Presumably, employers and carriers will still be able to raise these objections via the Board's RFA-2 but we are concerned that the Board did not address these objections directly in their announcement.
As of 8/15/22, payers will be required to use the new forms and should the old forms be submitted after that date, the Board will take no action.


Wojcik Wins Extreme Hardship Determination Case


Our partner, Melanie Wojcik, successfully defended an extreme hardship determination claim under WCB §35(3), receiving a favorable decision from a Board Panel on in Toys R Us. WCB Case No. 80801667 (4/22/22). In this case, the claimant was previously classified with an 80% loss of wage earning capacity and when he reached the durational limit of his permanent partial disability benefit, he applied for further benefits under the extreme hardship determination provision of WCB 35(3). During litigation, Melanie cross-examined the claimant, and established that the claimant's expenses were typical for someone on a fixed income, that some of the claimant's costs were discretionary and that the claimant made no effort to reduce his expenses. Nonetheless, the Law Judge found that the claimant met the criteria for extreme hardship and awarded ongoing benefits.

Melanie appealed the Law Judge's decision to the Board Panel. In an unanimous decision, the Board Panel overruled the Law Judge, finding that the mere fact that a claimant's expenses exceed his income does not, by itself, entitle that claimant to further benefits under an extreme hardship redetermination.

Our clients should remember to scrutinize claims for ongoing benefits under the extreme hardship determination provision. Please contact our office for advice and recommendations for any assistance.


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