This applicant for Workers' Compensation benefits [Claimant] worked as a mass transit customer service agent for the self-insured employer [Employer]. On January 14, 2021, Claimant was confronted by an emotionally disturbed person. This person came up to Claimant, then in her enclosed booth, and banged on the windows while screaming and threatening to kill her. Thereafter, claimant took a three-month unpaid leave from work under the Family and Medical Leave Act (29 USC §2601 et seq.) and was treated by a private medical provider.
When claimant returned to work she suffered a panic attack, and her supervisor advised her to file a workers' compensation claim. Claimant was referred to a medical provider authorized by the Workers' Compensation Board, who diagnosed her with causally-related anxiety and acute stress reaction.
Employer submitted a First Report of Injury form on June 15, 2021, indicating the Claim Type as "M — Medical Only" and the Agreement to Compensation as "L — With Liability." The Workers' Compensation Board issued a Notice of Case Assembly and advised the parties and Claimant filed a claim for workers' compensation benefits on June 21, 2021, asserting that she sustained post-traumatic stress disorder [PTSD]. The following day, June 22, 2021, Claimant began treating with a licensed social worker, who diagnosed her with causally-related PTSD, opined that she remained unable to return to work at that time and submitted a medical report to the Board.
Employer controverted the claim and argued that, because the Board had not indexed the case, the 25-day time period in which to file a notice of controversy under Workers' Compensation Law §25 (2) (b) had not been triggered. A Workers' Compensation Law Judge [WCLJ] found prima facie medical evidence of PTSD, agreed that Employer was entitled to controvert the claim and, thus, afforded it the opportunity to schedule an independent medical examination.
Employer later filed a Subsequent Report of Injury controverting and denying the claim based on, among other grounds, no compensable accident. Claimant's treatment providers were deposed in December 2021, and claimant testified at the next hearing regarding the incident and her inability to work.
The WCLJ credited Claimant's testimony but disallowed the claim, finding that the incident did not qualify as an accident in that Claimant testified that she frequently experienced verbal abuse while working in the transit system and, thus, did not establish that the stress that caused her psychiatric injury was greater than that which other similarly-situated workers experienced in a normal work environment.
Ultimately the Workers' Compensation Board [Boar] affirmed the decisions of the WCLJ, agreeing that, because it never indexed the claim, the provisions of Workers' Compensation Law §25 (2) (b) did not apply. The Board further upheld the WCLJ's finding of no compensable accident. Claimant appealed the Board's determination.
The Appellate Division reversed the Board's determination, noting the Board did not address any of the related arguments raised by Claimant, including:
1. Employer's First Report of Injury form, indicating acceptance of the claim with liability and that report was binding on Employer; and
2. Employer's subsequent actions in controverting the claim violated the purpose of 12 NYCRR 300.37(c).
The matter was remitted to the Board "for it to satisfy its obligation to address the issues raised by Claimant on administrative appeal and provide an explanation for its determination."
The Appellate Division also observed "The Attorney General elected not to participate in this matter, involving significant questions of statutory and regulatory interpretation, while urging this Court not to draw any adverse inference from that lack of participation. This was also the case the last time these arguments were raised to this Court" (see Matter of Williams v New York City Tr. Auth., 214 AD3d 1099) and "strongly encourage such participation on any potential appeal following this remittal".
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