There are three basic issues to be mindful of when challenging the denial of an application for disability benefits submitted by a member of the New York State
1. The applicant seeking disability retirement benefits bears the burden of demonstrating that he or she is permanently incapacitated from performing his or her job duties;
2. The State Comptroller is vested with the "exclusive authority" to determine an application for NYSERS disability retirement benefits; and
3. The Comptroller's decision will be sustained by the court if supported by substantial evidence.
The genesis of a CPLR Article 78 action was the Comptroller's denial of a New York State and Local Retirement System [NYSLRS] member's [Member] application for disability retirement benefits following the review of the findings and recommendation of a hearing officer made after a hearing pursuant to §74 of the Retirement and Social Security Law [RSSL].*
The Member contended that the medical records upon which the System based its initial denial of her application were erroneously admitted into evidence at the hearing. However, noted the Appellate Division, Member withdrew her objection to these records at the hearing and, thus, failed to preserve this issue for review by the Appellate Division is this Article 78 proceeding.
The Appellate Division then explained that in reviewing the determination of the Comptroller following a RSSL §74 hearing, the court is limited to considering whether the Comptroller's determination is supported by substantial evidence and in disability cases "substantial evidence" has been construed to require "some credible evidence." Further, said the court, the hearing officer was entitled to credit the evidence presented by NYSLRS' medical expert and "[i]t is within the exclusive authority of the Comptroller to evaluate the medical evidence and credit one medical opinion over another."
Further, opined the Appellate Division, the Comptroller's decision to credit one expert's opinion over the opinion of a another expert's is "dispositive where, as here, the credited expert provides an articulated, rational and fact-based opinion, founded upon a physical examination and review of relevant medical reports and records." The court then noted that NYSLRS' medical expert:
a. reviewed the medical records the Member submitted to the System;
b. conducted a physical examination of the Member; and
c. considered the letters from the Member's treating physicians stating that she was permanently disabled due to the conditions listed in her application as well as other resultant conditions.
a. reviewed the medical records the Member submitted to the System;
b. conducted a physical examination of the Member; and
c. considered the letters from the Member's treating physicians stating that she was permanently disabled due to the conditions listed in her application as well as other resultant conditions.
Noting that NYSLRS was entitled to credit the opinion set forth in its medical expert's supplemental report "because it was founded upon a physical examination and review of relevant medical reports and records," the Appellate Division ruled that the Comptroller's decision was supported by substantial evidence and dismissed Member's Article 78 petition.
* Member had submitted over 200 pages of medical records to NYSLRS' Medical Board. Member was then referred a physician for a medical examination. Following the examination the physician opined that Member's medical condition "should present no obstacle to her ability to work" and that "[f]rom an internal medicine standpoint, there are no findings in the records or examination to support a disabling condition." NYSLRS denied the Member's application. At the Member's request, a redetermination hearing was held before a hearing officer, at which time the Member offered additional medical records and Member's family physician testified concerning Member's medical issues. In addition, Member "submitted letters from other medical professionals" stating that Member was disabled due to "a constellation of symptoms and conditions." The hearing officer credited the opinion of NYSLRS' medical expert and recommended denying the Member's application for benefits.
The decision is posted on the Internet at: