October 05, 2018

Disallowing a workers' compensation claim based on the record as it then existed does not bar a claimant from submitting additional evidence to support the claim


Disallowing a workers' compensation claim based on the record as it then existed does not bar a claimant from submitting additional evidence to support the claim
Matter of Nock v New York City Dept. of Educ., 8 NY Slip Op 02693, Appellate Division, Third Department

Tykeisha D. Nock [Nock], a school lunch helper, filed a claim for workers' compensation benefits claiming that she had sustained injuries to her spinal cord, lower back, legs, feet and thighs while standing, cleaning tables and lifting heavy pans at work.

Nock's employer, the New York City Department of Education* [Education] controverted the claim. A Workers' Compensation Law Judge found that Education's  notice of controversy was untimely and established a claim for a work-related injury to Nock's back. The Workers' Compensation Board, however, ultimately determined that Nock had not submitted proof that she had sustained a causally-related injury, and disallowed her claim.

Although Education's failure to file a timely notice of controversy challenging Nock's workers' compensation claim barred it from raising certain defenses, Nock still has the burden of demonstrating a causal relationship between her employment and the medical condition she alleged was work related in the workers' compensation claim filed with the Workers' Compensation Board. Nock appealed.

The Appellate Division sustained the Board's ruling, finding:

1. Nock's threshold obligation to submit prima facie medical evidence, which the Board found she had satisfied, required only that she submit "a medical report referencing an injury, which includes traumas and illnesses" but did not require that such "evidence draw a causal link between the injury and [Nock's] employment."

2. In order to establish her claim for benefits, Nock bore the burden of demonstrating, "by competent medical evidence, that a causal connection existed between her injur[ies] and her employment" and such proof  "must signify a probability as to the underlying cause of the [Nock's] injury which is supported by a rational basis."

3. Nock's medical evidence consisted solely a report from a physician indicating that she had a spinal injury and underwent surgery and recorded her subjective complaints and physical findings, while noting that her prognosis was "poor."

The Appellate Division said that the physician's report contained no specific diagnosis, make no mention of the history of Nock's injury nor how it related to her work at Education and, although the report made reference to other medical providers and tests, "no other evidence was submitted."

Explaining that a medical opinion need not be expressed with "medical certainty," the Appellate Division found that Nock failed to submit any medical evidence providing a causal link between her injury and her employment. Thus, said the court, it discerned no basis upon which to disturb the Board's finding that Nock failed to establish her claim.

As to Nock contention that it "was improper for the Board to terminate her claim without providing her an opportunity to submit additional medical evidence," the Appellate Division noted that the Board did not outright deny her claim but, rather, "disallowed the claim based on the record as it existed" and declared that "[n]o further action is planned at this time." The court said that it did not read the Board's decision as precluding Nock from submitting further medical evidence of a causal relationship between her injury and her employment with Education, explaining that Board's statement that "no further action is planned at this time" generally indicates that "the claim is merely currently inactive" and presumably may be "reactivated" should Nock present the Board with additional relevant medical evidence within a reasonable period of time.

* Department of Education is a self-insured employer.

The decision is posted on the Internet at:

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