Claim of State Ins. Fund, 7 N.Y.3d 832 (2006)

When a workers’ compensation case is closed without a determination of permanent disability and is later reopened, the 104-week limitation for filing a claim with the Special Disability Fund does not apply, even if the initial closure occurred more than 104 weeks after the date of disability.

Summary

This case addresses the timeliness of a claim for reimbursement from the Special Disability Fund (SDF) under New York’s Workers’ Compensation Law. A worker’s compensation claim was initially closed without a finding of permanent disability after the 104-week statutory period. The case was later reopened, and the State Insurance Fund (SIF) filed a claim with the SDF. The Court of Appeals held that because the case was closed without a determination of permanency and subsequently reopened, the 104-week limitation did not bar the SIF’s claim, even though the initial closure happened after the 104-week period. The court emphasized the purpose of the SDF—to provide reimbursement when a claim initially seems less serious but proves more substantial upon reopening.

Facts

A worker filed a claim for worker’s compensation benefits. The claim was closed without a determination of permanent disability. The initial closure occurred more than 104 weeks after the date of the disability. Later, the case was reopened for further consideration. After reopening, the State Insurance Fund (SIF), the worker’s compensation carrier, filed a claim with the Special Disability Fund (SDF) seeking reimbursement. The case ultimately resulted in a determination of permanent disability for the worker. The Special Disability Fund conceded it would be liable for reimbursement if the claim was timely filed.

Procedural History

The case was initially handled by the Workers’ Compensation Board. After the case was reopened and a determination of permanency was made, the issue of the timeliness of the claim against the Special Disability Fund arose. The Appellate Division held the State Insurance Fund’s claim to be timely. The Special Disability Fund appealed to the Court of Appeals.

Issue(s)

Whether the 104-week limitation for filing a claim with the Special Disability Fund applies when a workers’ compensation case is closed without a determination of permanent disability, and then reopened, even if the initial closure occurred more than 104 weeks after the date of disability?

Holding

No, because Workers’ Compensation Law § 15 (8) (f) provides that the 104-week limitation does not apply to a case that has been closed without a finding of permanent disability and then reopened, regardless of when the closure occurs relative to the date of disability.

Court’s Reasoning

The Court of Appeals interpreted Workers’ Compensation Law § 15 (8) (f), which governs the timeframe for filing claims for reimbursement from the Special Disability Fund. The SDF argued that the clause regarding reopened cases should only apply when the initial closure occurs *before* the expiration of the 104-week period. The Court rejected this interpretation, finding that the statute’s language did not support such a reading. The Court emphasized the purpose of the Special Disability Fund: “to permit an application to the Fund where a claim that initially seemed unlikely to result in a finding of permanent disability turns out, on reopening, to be a more serious claim than it first appeared.” The Court cited Matter of Burch v Hawkins, 9 AD2d 6, 8 (3d Dept 1959), supporting the view that the 104-week limitation is inapplicable in reopened cases where permanency was not initially determined. The court recognized that applying the statute literally led to the revival of a claim that would otherwise be time-barred, but held that this was the intended effect of the statute. Chief Judge Kaye and Judges Ciparick, Graffeo, Read, Smith and Pigott concurred.