November 25, 2020

The Workers' Compensation Board's determination whether a claimant violated §114-a of the Workers' Compensation Law will not be disturbed if supported by substantial evidence

The Workers' Compensation Board [Board] rejected the employer's [Employer] claim the there were procedural errors in its employee's [Claimant] claims for benefits and said that the Board would exercise its discretion to grant review of the application filed by the Claimant in consideration of "Claimant's substantial completion of question number 13 on the application for workers' compensation benefits form." The Board then reversed the decision of the Workers' Compensation Law Judge [WCLJ] holding that that Claimant had violated §114-a Workers' Compensation Law,  finding there was insufficient evidence to support the WCLJ's determination. The employer appealed the Board's decision.

The Appellate Division said that Employer principally argued that Claimant's response to question number 13 was not complete and that the Board therefore lacked the authority and discretion to review Claimant's application for benefits, citing 12 NYCRR 300.13(b).

The court rejected the Employer's argument, holding that the Board has the "authority to adopt reasonable rules consistent with and supplemental to the provisions of the Workers' Compensation Law," and the Chair of the Board may "make reasonable regulations consistent with the provisions of the statutory framework." 

Noting that Employer was correct that 12 NYCRR 300.13 [b] [1] of the Board's regulations require an applicant seeking Board review "to fill out the RB-89 form completely and in the proper format," the Appellate Division said that the Board's regulations "do not mandate denial of an incomplete application for Board review." Rather, the court explained that the regulations provide that such an "application for review maybe denied" [sic]  by the Board, in its discretion, where the application "does not comply with prescribed formatting, completion and service submission requirements."

Considering Claimant's response to question number 13 on her application for Board review, which listed numerous documents in support of her administrative appeal, the Appellate Division held that the Board:

[1] acted within its discretion in granting review of Claimant's application: and

[2] acted within its discretion to excuse any alleged defects relating to the timeliness and proper service of Claimant's application for Board review.

Addressing the merits of Claimant's application for benefits, the Appellate Division pointed out that §114-a(1) of the Workers' Compensation Law provides that a claimant who, for the purpose of obtaining workers' compensation benefits, or to influence any determination related to payment thereof:

1. Knowingly makes a false statement or representation as to a material fact ... shall be disqualified from receiving any compensation directly attributable to such false statement or representation;"

2. For purposes of Workers' Compensation Law §114-a (1), a fact is material "so long as it is significant or essential to the issue or matter at hand;" and

3. An omission of material information "may constitute a knowing false statement or misrepresentation".

However, the Board, declared the Appellate Division, is the sole arbiter of witness credibility and its determination as to whether a claimant violated §114-a Workers' Compensation Law "will not be disturbed if supported by substantial evidence."

After considering the evidence in the record the Appellate Division opined that the Board's finding that Claimant did not make a misrepresentation of a material fact to obtain workers' compensation benefits "is supported by substantial evidence and will not be disturbed."

The decision is posted on the Internet at http://www.nycourts.gov/reporter/3dseries/2020/2020_06832.htm

 

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