April 23, 2021

Failure to fully comply with the relevant rules and regulations may prove fatal to filing a viable administrative appeal of an adverse administrative decision

The Workers' Compensation Board declined to review of a decision by a Workers' Compensation Law Judge on the grounds that the self-insured employer [Employer] failed to comply with the controlling provisions of its rules and regulations.

A correction officer [Claimant] assaulted by an inmate filed a claim for workers' compensation benefits for an injury to his jaw and for "post-concussive syndrome and photophobia." A Workers' Compensation Law Judge [WCLJ) amended the claim to include an injury to the Claimant's head and found, among other things, that Claimant "is totally industrially disabled based upon his work-related injuries and legal blindness."

The Employer filed an application for review of the WCLJ's determination by the Workers' Compensation Board, challenging, among other things, the WCLJ's finding that [Claimant was] totally industrially disabled. The Board denied the application for Board review of the WCLJ's ruling because of Employer did not answer a question on the application form it had submitted seeking such review. Employer next appealed the Board's rejection of its application for review.

The Appellate Division affirm the Board's decision, noting that it had "consistently recognized that 'the Board may 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 thereof.'"

The court explained that the regulations require, in relevant part, that "an application to the Board for administrative review of a decision by a [WCLJ] shall be in the format as prescribed by the Chair [and] . . . must be filled out completely",* noting that "[w]here, as here, a party who is represented by counsel fails to comply with the formatting, completion and service submission requirements set forth by the Board, the Board may, in its discretion, deny an application for review."

Further, opined the court, Employer's reliance on "its responses to other questions on the application for Board review does not cure the defective response to question number 15," the specific question which the Board found was not answered.

* See 12 NYCRR 300.13[b]

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

 

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