Sunday, January 31, 2010
Employee must show a causal relationship between injury and employment to be eligible for workers’ compensation benefits
North Syracuse CSD school bus attendant Diane Norton sustained a compensable injury and awarded her workers' compensation benefits. North Syracuse, a self-insurer for workers’ compensation, controverted [objected to] the claim.*
The Workers' Compensation Board sustained a Workers’ Compensation Law Judge’s ruling finding that Norton a causal relationship between the nature of Norton’s employment and her disability. The District appealed the Board’s determination.
The Appellate Division, noting that "It is axiomatic that a claimant [seeking workers’ compensation benefits] bears the burden of establishing a causal relationship between his or her employment and a disability by the proffer of competent medical evidence," said that "a medical opinion on the issue of causation must signify 'a probability as to the underlying cause' of the claimant's injury which is supported by a rational basis."
In this case the Appellate Division concluded that Norton had not met her burden of demonstrating a causal relationship between her employment and her disability.
A medical expert, Brett Greenky, a board-certified orthopedic surgeon, testified how a fracture such as the one Norton sustained can occur and stated that her report of injury was "[p]otentially consistent" with the fracture that she sustained. Dr Greenky, however, also testified, "I don't have an opinion about when it happened and how it happened."
As Dr. Greenky's medical testimony “falls short of the required degree of medical proof,” the Appellate Division ruled that the Board's determination lacked a rational basis and was not supported by substantial evidence. The court reversed the Board’s ruling and remanded the matter to it “for further proceedings not inconsistent with this Court's decision.”
25.2 of the Workers’ Compensation Law, in pertinent part, provides: “In
case the employer decides to controvert the right to compensation, it
shall, either on or before the eighteenth day after disability or
within ten days after it has knowledge of the alleged accident,
whichever period is the greater, file a notice with the chair, on a
form prescribed by the chair, that compensation is not being paid,
giving the name of the claimant, name of the employer, date of the
alleged accident and the reason why compensation is not being paid.
Reprinted with permission New York Public Personnel Law
Mitchell H. Rubinstein