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April 12, 2011

Eligibility for General Municipal Law §207-a benefits and for Workers’ Compensation Benefits are not linked and are to be determined on their own merits

Eligibility for General Municipal Law §207-a benefits and for Workers’ Compensation Benefits are not linked and are to be determined on their own merits
Matter of Davidson v LaGrange Fire District, 2011 NY Slip Op 02666, Appellate Division, Second Department

Deborah A. Davidson filed and Article 78 action “in the nature of mandamus,” seeking an order to compel the LaGrange Fire District to make a final determination regarding her application for medical benefits under General Municipal Law §207-a.

Davidson has sustained an injury on a fire call and the Fire District awarded her salary benefits pursuant to General Municipal Law §207-a. However, Davidson had also asked for certain medical benefits related to her work-connected injury that had been denied by the New York State Insurance Fund, the Fire Districts workers' compensation insurance carrier.

An administrative law judge for the Workers’ Compensation Board had ruled that the State Insurance Fund was liable for the full cost of the Davidson’s surgery but the Fund had filed an application seeking a review by the Workers’ Compensation Appeals Board.

Before a decision was issued by the Board, Davidson filed her CPLR Article 78 petition. The petition, among other things, sought an order in the nature of mandamus, in effect, to compel the respondents to issue a final determination as to the her request for medical benefits under General Municipal Law §207-a.

Supreme Court denied Davidson’s petition ruling that it was premature as she had not exhausted her administrative remedies before the New York State Workers' Compensation Board concerning her claims. The Appellate Division reversed the lower court’s ruling.

The Appellate Division explained that in the event an officer or agency fails or refuses to conduct a hearing or decide a particular matter where there was a mandatory, nondiscretionary duty to do so, mandamus is appropriate to compel performance of the required duty.

Davidson argued that although the Fire District had made a determination that she is entitled to receive benefits under General Municipal Law §207-a, had not made a determination regarding coverage under General Municipal Law §207-a for her medical expenses.

As a determination by the WCB regarding workers' compensation benefits, and a determination by a municipal employer regarding statutory benefits pursuant to General Municipal Law §207-a, are separate and distinct matters, which the Court of Appeals had made clear in Matter of Balcerak v County of Nassau (94 NY2d 253), “[a] municipality's obligation to pay wages and medical costs under General Municipal Law §207-a or § 207-c is in no way dependent upon any determination made by the WCB.”

In the words of the Appellate Division, quoting Balcerak, "the eligibility determinations for these distinct types of statutory benefits" must "stand and be resolved essentially on their own merits."*

Here, any workers' compensation remedies that may have been available to Davidson were separate from and independent of her request that Fire District provide coverage for the full cost of medial expenses pursuant to General Municipal Law §207-a. Accordingly, said the court, she was not required to exhaust her administrative remedies in the workers' compensation proceeding before pursuing this CPLR Article 78 proceeding against the Fire District.

The matter was remanded to Supreme Court for further proceedings on Davidson’s petition, “and a new determination thereafter.”

* In Balcerak the Court of Appeals held that a determination by the WCB that an injury is work-related does not, by operation of collateral estoppel, automatically entitle an injured employee to benefits under General Municipal Law §207-c [which applies to law enforcement personnel], which ruling presumably would be controlling in a GML §207-a case [which applies to firefighting personnel].

The decision is posted on the Internet at:
http://www.courts.state.ny.us/reporter/3dseries/2011/2011_02666.htm
.

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