New York Law Review

Tag: Permanent Partial Disability

  • Zamora v. New York Neurologic Associates, 17 N.Y.3d 186 (2011): Inference of Causation in Workers’ Compensation Cases

    Zamora v. New York Neurologic Associates, 17 N.Y.3d 186 (2011)

    In workers’ compensation cases involving permanent partial disability, the Workers’ Compensation Board is permitted, but not required, to infer that a claimant’s subsequent loss of wages is attributable to physical limitations caused by the workplace accident; the Board must consider all relevant factors when determining causation.

    Summary

    Rocio Zamora, a phlebotomist, suffered a workplace injury. After returning to full-duty work, she later quit due to various health issues, some related and some unrelated to the accident. She sought workers’ compensation benefits, but the Board denied her claim, finding she hadn’t conducted a reasonable job search consistent with her restrictions. The Appellate Division reversed, inferring that her loss of wages was attributable to her disability. The Court of Appeals reversed, holding that the Board is not required to draw that inference and that substantial evidence supported the Board’s finding that Zamora did not conduct a reasonable job search.

    Facts

    Rocio Zamora, a phlebotomist for New York Neurologic Associates, was injured when a computer monitor fell on her. She suffered a torn tendon and herniated discs. She took time off work and received benefits. Zamora returned to full-duty work but quit again later due to migraines, numbness, and back pain, some of which were related to the original accident. She sought work, but had difficulty finding a job due to physical limitations.

    Procedural History

    A Workers’ Compensation Law Judge found Zamora had not voluntarily removed herself from the labor market. The insurance carrier sought review. The Workers’ Compensation Board denied Zamora’s claim, stating she failed to conduct a reasonable job search. The Appellate Division reversed, inferring causation between her disability and wage loss. The Court of Appeals granted review and reversed the Appellate Division’s order.

    Issue(s)

    Whether the Workers’ Compensation Board must infer, from the finding that a claimant withdrew from her employment due to an accident at her workplace, that her post-accident loss of wages is attributable to physical limitations caused by the accident.

    Holding

    No, because the Workers’ Compensation Board is permitted, but not required, to infer that a claimant’s subsequent loss of wages is attributable to physical limitations caused by the workplace accident.

    Court’s Reasoning

    The Court of Appeals stated that the Board must resolve whether a claimant has maintained a sufficient attachment to the labor market, demonstrating that the cause of their reduced income is a disability, not an unwillingness to work. The Court clarified that the Board may infer causation from a disability-related withdrawal, considering the nature of the disability and the claimant’s work. The Court rejected the Third Department’s view that the Board *must* find causation, stating that this view “effectively created [a] . . . presumption out of an inference”. The Court emphasized that its holding prevents shifting the burden of proof from claimant to employer. The Court also found substantial evidence supported the Board’s finding that Zamora had not made a reasonable search for work consistent with her physical restrictions. The dissent argued that an inference of loss in wage earning capacity arises where the claimant left their job because of the disability and the burden shifts to the employer to rebut that inference.

  • Burns v. Varriale, 9 N.Y.3d 207 (2007): Apportionment of Attorney’s Fees in Workers’ Compensation Cases with Nonschedule Permanent Partial Disabilities

    9 N.Y.3d 207 (2007)

    In workers’ compensation cases involving nonschedule permanent partial disabilities, the value of future benefits is too speculative to allow for the present apportionment of attorney’s fees based on the carrier’s anticipated relief from those future payments.

    Summary

    Owen Burns, a police officer, sustained permanent injuries in a motor vehicle accident during his employment and was classified as permanently partially disabled, receiving ongoing workers’ compensation benefits. He later settled a third-party personal injury action related to the accident. A dispute arose regarding the apportionment of attorney’s fees between Burns and the workers’ compensation carrier, Travelers, specifically concerning the carrier’s future relief from benefit payments due to the settlement. The New York Court of Appeals held that because the value of future benefits for a claimant with a nonschedule permanent partial disability is speculative and cannot be reliably ascertained at the time of a third-party settlement, Burns was not entitled to an immediate apportionment of attorney’s fees based on those future benefits.

    Facts

    Owen Burns, a police officer, was injured in a motor vehicle accident while on duty. He sustained permanent injuries and was classified as permanently partially disabled, receiving $400 per week in workers’ compensation benefits. Burns sued the other driver, Varriale, and reached a settlement for the full amount of Varriale’s insurance policy ($300,000). Travelers, the workers’ compensation carrier, asserted a lien against the settlement proceeds for past benefits paid. A dispute arose concerning the apportionment of attorney’s fees, particularly regarding the value of future benefits Travelers would be relieved from paying due to the settlement.

    Procedural History

    Burns petitioned the Supreme Court to compel Travelers to consent to the settlement, extinguish Travelers’ lien, and direct Travelers to pay “fresh money” because its share of attorney’s fees exceeded the lien amount. Travelers consented but reserved its right to a credit against future benefits. Supreme Court granted Burns’ petition, extinguishing the lien and ordering Travelers to pay “fresh money.” The Appellate Division modified the Supreme Court’s order, directing Burns to pay Travelers the value of its lien reduced by its share of litigation costs. The Court of Appeals affirmed the Appellate Division’s decision.

    Issue(s)

    Whether the present value of future workers’ compensation benefits for a claimant with a nonschedule permanent partial disability is ascertainable at the time the claimant recovers damages in a third-party action such that the claimant is entitled to an immediate apportionment of attorney’s fees based on the carrier’s relief from paying those future benefits.

    Holding

    No, because the value of future workers’ compensation benefits for a claimant with a nonschedule permanent partial disability is speculative and cannot be reliably ascertained at the time of a third-party settlement.

    Court’s Reasoning

    The Court reasoned that unlike death benefits, permanent total disability benefits, or schedule loss of use awards, benefits for permanent partial disabilities are inherently uncertain. These benefits depend on the claimant’s continued attachment to the labor market, their actual earnings, and other factors that can change over time. The Court stated, “[I]n a permanent partial disability case, whether a claimant has maintained a sufficient attachment to the labor market must be resolved by the Board in determining his or her reduced earning capacity and whether benefits should be awarded.” Because the rate and duration of these benefits may fluctuate, the value of future compensation payments is too speculative for an immediate apportionment of attorney’s fees. The Court distinguished this situation from death benefit cases, where benefits are paid at a set rate for life unless the spouse remarries, or permanent total disability cases, where there is no expectation of returning to the workforce. The Court emphasized that while immediate apportionment is not possible, the carrier can be required to periodically pay its equitable share of attorney’s fees as continuous compensation benefits are awarded. The trial court can fashion a means of apportioning litigation costs as they accrue and monitoring how the carrier’s payments to the claimant are made. This ensures that the carrier’s payment of attorney’s fees is based on an actual, nonspeculative benefit. The court quoted Matter of Kelly v. State Ins. Fund, 60 N.Y.2d 131, 138 (1983): “[Equitable apportionment] was purposely adopted to avoid ‘rigid statutory formulas’ and to implement a ‘practical and flexible’ approach towards ensuring that a compensation carrier assumes its fair share of the costs of litigation.”

  • Matter of Pellicci v. Republic Aviation Corp., 49 N.Y.2d 389 (1980): Workers’ Comp Benefits During Confinement for Criminal Insanity

    Matter of Pellicci v. Republic Aviation Corp., 49 N.Y.2d 389 (1980)

    A claimant with a prior work-related permanent partial disability is entitled to continued workers’ compensation benefits even during confinement in a psychiatric ward for the criminally insane, provided the underlying disability persists.

    Summary

    This case addresses whether a claimant with a pre-existing work-related disability should continue receiving workers’ compensation benefits while confined to a psychiatric ward after being acquitted of a crime due to insanity. The New York Court of Appeals held that such confinement does not automatically preclude the claimant from receiving benefits, as the purpose of workers’ compensation is to protect workers from hardship due to injury, and subsequent mental illness shouldn’t negate those benefits if the original disability continues. Suspending benefits could discourage treatment and worsen the worker’s condition.

    Facts

    The claimant suffered a back injury in 1959 while employed in New York, and was awarded workers’ compensation benefits for a permanent partial disability. In 1976, while in Italy, he was arrested for fatally shooting two people. An Italian court declared him not responsible for his actions due to total insanity at the time of the crime and ordered him committed to a hospital for the criminally insane for at least ten years.

    Procedural History

    The employer and its insurance carrier sought to suspend the claimant’s workers’ compensation benefits during his confinement. The Workers’ Compensation Board granted the suspension. The Appellate Division reversed, holding that the claimant was entitled to continued benefits. The New York Court of Appeals affirmed the Appellate Division’s decision.

    Issue(s)

    Whether a claimant with a prior work-related permanent partial disability is entitled to continue receiving workers’ compensation benefits during the period he or she is confined to a psychiatric ward after being acquitted of a crime due to insanity.

    Holding

    Yes, because the purpose of workers’ compensation is to protect workers from hardship caused by work-related injuries. Suspending benefits due to subsequent mental illness would compound the hardship and could discourage the claimant from seeking necessary treatment, and the claimant’s underlying disability continued to exist.

    Court’s Reasoning

    The court emphasized the broad purpose of the Workers’ Compensation Law, which is to protect workers from economic hardship resulting from work-related injuries. The court reasoned that denying benefits to a claimant solely because of subsequent mental illness would not further the goals of the law. In fact, the court noted that mental illness often increases the need for such benefits. The court distinguished this situation from cases where benefits are denied due to criminal conviction, because in this case, the claimant was acquitted due to insanity, meaning that he was found not responsible for his actions. The court cited Matter of Papkoff v. Feldman, stating that there is “no basis, in authority or in reason, for [the] unqualified conclusion that a claimant may not collect payments awarded to him for permanent partial disability unless he is in the labor market. The fortuitous circumstance that a claimant who has sustained a permanent partial disability is subsequently hospitalized… should not inure to the benefit of the carrier while the physical and industrial disability and the loss of wage-earning capacity on which the award was bottomed still continue.” The court explicitly rejected the argument that the claimant’s commitment was the equivalent of a criminal conviction.