March 07, 2019

An employee found eligible for accidental disability retirement after an accident at work aggravated a dormant medical condition


An employee found eligible for accidental disability retirement after an accident at work aggravated a dormant medical condition
Petras-Ross v DiNapoli, 2019 NY Slip Op 00939, Appellate Division, Third Department

A school crossing guard [Petitioner] employed by the Suffolk County Police Department was assisting a child cross the street when she was struck by a passing vehicle and was knocked to the ground. She got up, continued to escort the child and reported the incident to her supervisor. Subsequently Petitioner obtained medical treatment and underwent physical therapy, eventually returning to full-time work. Continuing to suffer pain while performing her duties, Petitioner ultimately stopped working completely and filed an application for accidental disability retirement benefits pursuant to Retirement and Social Security Law Article 15 claiming that she was permanently incapacitated due to back injuries that she sustained in the accident.

The New York State and Local Retirement System [ERS] denied her application on the ground that her disability was not the natural and proximate result of the accident. A Hearing Officer denied her application on the same ground following a hearing and the Comptroller later adopted the Hearing Officer's findings and decision. Petitioner sued, challenging the Comptroller's denial of her application for accidental disability retirement benefits.

The Appellate Division, noting that both Petitioner and ERS "concede that [Petitioner] is permanently incapacitated from performing her duties," said that the only issue to be resolved is whether Petitioner met her burden of demonstrating that her  back injuries were causally related to the accident.

The court said that the medical experts who examined petitioner all agreed that she suffers from degenerative disc disease of the lumbar spine but provided conflicting medical opinions as to the cause of Petitioner's disabling back condition. 

Noting that the Comptroller retains the authority to resolve conflicting medical opinions and may credit the opinion of one expert over another, the Appellate Division said that the expert medical opinion relied upon by the Comptroller in making the decision must be a "rational and fact-based opinion founded upon a physical examination and review of the pertinent medical records."

In this instance, however, the Appellate Division found that the ERS' medical expert's opinion was not substantiated by the record developed by the Hearing Officer and "documented in the police report, [Petitioner's] disability retirement application and certain medical records." In addition, Petitioner had testified at the hearing that she had sustained trauma to her back and that she felt pain in her back the day after the accident and the medical records reveal that she verbalized her complaints of back pain following the accident.

In the words of the court, "although [ERS' medical expert] correctly observed that [Petitioner] returned to work ... he disregarded the fact that she stopped working completely ... because she continued to experience significant pain in various parts of her body, including her back."

Accordingly, the court found that ERS' medical expert did not provide a rational, fact-based opinion supporting the denial of Petitioner's application for accidental disability retirement, explaining that although the medical evidence suggests that Petitioner suffered from an underlying degenerative back condition that was asymptomatic, "when a preexisting dormant disease is aggravated by an accident, thereby causing a disability that did not previously exist, the accident is responsible for the ensuing disability."

Concluding that the Comptroller's determination was not supported by substantial evidence, the Appellate Division ruled that it must be annulled and remitted the matter to the Comptroller "for further proceedings not inconsistent with this Court's decision."

The decision is posted on the Internet at:

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