January 11, 2021

A claimant seeking workers' compensation benefits must show a causal nexus between the accident underlying his claim and his employment

A Chief of Police [Claimant] of a Village in New York State filed for workers' compensation benefits in connection with injuries he sustained in a motor vehicle accident that occurred while he was driving a police vehicle. The Village's workers' compensation carrier controverted the claim. Ultimately the Workers' Compensation Board [Board] awarded Claimant workers' compensation benefits and the Village's workers' compensation insurance carrier [Carrier] appealed the Board's ruling.

The record indicated that Claimant was involved in the accident in the course of his taking a weekend trip, about a 4½ drive from the Village. Claimant had testified that "he carried his work cell phone, that he was on call 24 hours a day and that he drove his police vehicle to his weekend destination so that he could return to the Village if needed." Claimant also testified that:

1. He was not recalled at any point during the weekend;

2. He was not in the course of returning to work at the time of the accident; and

3. He was he attending to any other police matter at the time of the accident. 

After considering some procedural matters, the Appellate Division said that it agreed with the Workers' Compensation Board [Board] that the Carrier was precluded from submitting evidence on the issue of whether Claimant's injuries arose out of and in the course of Claimant's employment having waived such defenses.

The court, however, pointed out that the Carrier's waiver of its defenses did not relieve Claimant of his obligation to come forward with sufficient proof to establish that he suffered a compensable injury in the course of his employment. According, said the court, Claimant had the burden of demonstrating that "a sufficient causal nexus existed between his employment and the motor vehicle accident that caused his injuries" to support of his application for workers' compensation benefits.

The Appellate Division explained that the degree of control exercised by the employer over a claimant's activities at the time of the accident was a critical element "in determining whether the requisite causal nexus exists," a factual question for the Board. Further, the Board's determination regarding the required nexus will be upheld if supported by substantial evidence.

As Claimant offered no other testimony linking his weekend activities to his employment by the Village, the Appellate Division opined that the evidence offered by Claimant "falls short of demonstrating the requisite causal nexus between Claimant's accident and his employment." 

Accordingly, the court held that the Board's decision is not supported by substantial evidence and remitted the matter to the Board for further proceedings.

Click here to access the text of the Appellate Division's decision.

 

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