Workers’ compensation and Section 207-a/207-c disability claims

Workers’ compensation and Section 207-a/207-c disability claims

Balcerak v Nassau County, Ct. of Appeals, 93 NY2d 808

If a police officer is awarded workers’ compensation benefits before his or her employer decides whether or not he or she is eligible for disability benefits under Section 207-c of the General Municipal Law, may the appointing authority still deny the individual’s application for Section 207-c benefits? Yes, said the Court of Appeals, in a unanimous opinion, reversing a decision by the Appellate Division to the contrary.

Until this ruling, various appellate division and Supreme Court decisions held that the employer was prevented from rejecting the police officer’s Section 207-c claim under such circumstances under the doctrine of collateral estoppel. In fact, one Supreme Court justice recently ruled that the mere filing of a workers’ compensation claim by the employer, which it was mandated to do by law, prevented it from denying the individual’s Section 207-c application.

In Balcerak, the Court of Appeals concluded that Gregory Balcerak, a Nassau County corrections officer was not automatically entitled to Section 207-c benefits simply because the Workers’ Compensation Board had determined that he had suffered a work-related injury and that the doctrine of collateral estoppel did not apply in such cases.*

Balcerak had been injured in an automobile accident in June 1996, just after leaving from his assignment to special duty on the “midnight shift.” Nassau rejected his application for Section 207-c benefits for his “injury sustained while on duty form” on September 9, 1997. The Workers’ Compen­sation Board, however, had approved Balcerak’s application for workers’ compensation benefit before the county had made its determination.

Balcerak sued, demanding that Nassau provide him with “Section 207-c benefits, retroactive to the date of the accident.

A Supreme Court justice concluded that the Nassau was bound by the Workers’ Compensation Board’s finding that Balcerak was injured while on duty. The Appellate Division affirmed, agreeing that the collateral estoppel doctrine applied against the County.

The Court of Appeals reversed, holding that the Workers’ Compensation Law and the General Municipal Law are discrete, independent compensation systems and that a favorable Workers’ Compensation determination does not, therefore, automatically entitle an employee to the special benefits provided by Section 207-c.**

According to the ruling, the Workers’ Compensation Board’s determination does not automatically preclude a municipality’s discrete decision on a General Municipal Law Section 207-c application. The distinction between the two laws made by the Court of Appeals:

1. Section 207-c benefits were meant to fulfill a narrow and important purpose ... to compensate specified municipal employees for injuries incurred in the performance of special work related to the nature of heightened risks and duties.***

2. Workers’ Compensation is a general and comprehensive social program designed to provide all injured employees with some scheduled compensation and medical expenses, regardless of fault for ordinary and unqualified employment duties.

In view of this ruling, it appears that in evaluating a claim for Section 207-c benefits, the appointing authority should:

1. Determine if an individual is unable to perform the duties of his or her position because of a disability.

2. If it is determined that the individual is disabled, was the individual disabled as the result of a work-related injury or disease? If the answer is no, the individual is probably eligible for disability leave pursuant to Section 72 of the Civil Service Law.

3. If it is determined that the individual was disabled on the job, was the injury or disease at work incurred in the performance of “official duties” as a police officer? If the answer is no, the individual is probably still eligible for leave pursuant to Section 71 of the Civil Service Law, Workers’ Compensation Leave.

4. If it is determined that the individual was disabled as a result of his or her performing “official duties,” he or she is presumably eligible for Section 207-c benefits as provided by law.

Some collective bargaining agreements negotiated pursuant to the Taylor Law set out procedures for the processing of Section 207-c applications.

* Although this case concerned Section 207-c, which covers police officers, while Section 207-a of the General Municipal Law applies to firefighters injured in the line of duty, the rationale adopted by the Court of Appeals in making its determination would probably be followed in a similar Section 207-a case.

** This decision did not end the matter regarding Balcerak’s eligibility for 207-c benefits. The Court of Appeals said that its ruling “resolves only the collateral estoppel issue....” The other issue in this action -- did Nassau have “a rational basis for its decision denying Balcerak Section 207-c benefits,”, had not yet addressed by the Appellate Division. Accordingly, the case was returned to the Appellate Division for its consideration of this issue.

*** N.B. Subsequently the Court of Appeals revisited and clarified its view regarding the availability of Section 207-c benefits based on a perception of “heightened risks and duties,” holding that “[I]n order to be eligible for Section 207-c benefits, a covered municipal employee need only prove a ‘direct causal relationship between job duties and the resulting illness or injury’.” (see Matter of Theroux v Reilly, 1 NY3d 232 

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General Municipal Law§§ 207-a and 207-c - a 1098 page e-book focusing on administering General Municipal Law Sections 207-a/207-c and providing benefits thereunder is available from the Public Employment Law Press. Click on http://section207.blogspot.com/ for additional information about this electronic reference manual.

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