All relevant medical records must be considered in making a determination regarding an application for accidental disability retirement benefits

All relevant medical records must be considered in making a determination regarding an application for accidental disability retirement benefits

Baird v New York State & Local Retirement Sys., 2012 NY Slip Op 05053, Appellate Division, Third Department

Darlene A. Baird was employed by the Westchester County Department of Social Services. She was injured in the course of performing a physical test during an interview for another position with the Department.

Although Baird returned to work, she left after three days due to pain in her right shoulder and arm. When she subsequently applied for accidental disability retirement benefits, her application was denied based on the Retirement System's expert finding that she was not permanently incapacitated from the performance of her job duties. The Comptroller sustained the hearing officer’s determination and Baird appealed.

The Appellate Division said that the Retirement System's determination relies primarily upon the report of its physician, Dr. Charles Ricciardelli. Based on his examination of Baird, Dr. Ricciardelli concluded that although she had pain in her right upper arm caused by the accident, she was "exaggerating the pain, and had only a mild, partial disability."

However, said the court, the record includes the report of an MRI of Baird's right shoulder taken after Dr. Ricciardelli examined her indicated that Baird had a biceps tendon tear. As the record did not indicate that Dr. Ricciardelli was given the chance to review the right shoulder MRI report; nor did the Retirement System call him to testify, “there is no basis for concluding that his opinion would have remained unchanged in light of the new information contained [in the MRI report].

Although the Comptroller is vested with authority to evaluate conflicting medical opinions and credit the opinion of one expert over that of another, the Appellate Division said that the medical proof relied upon “must articulate a rational, fact-based opinion based upon a physical examination and review of all the relevant medical records.”

Accordingly, the Appellate Division ruled that as Dr.Ricciardelli had not been given the opportunity to clarify his opinion based upon a review of all the relevant medical records, the Comptroller's determination was not supported by substantial evidence and must be annulled and remitted for further proceedings.

The decision is posted on the Internet at:

http://www.courts.state.ny.us/reporter/3dseries/2012/2012_05053.htm

Municipality may have voluntarily assumed a special duty to an injured employee based on "justifiable reliance"

Municipality may have voluntarily assumed a special duty to an injured employee based on "justifiable reliance" 

Morgan-Word v New York City Dept. of Educ., 2012 NY Slip Op 05151, Appellate Division, Second Department

Assistant Principal Rolanda Morgan-Word alleged that she was injured while attempting to break up a fight between two students at a school. Supreme Court denied the New York City Department of Education’s motion for summary judgment dismissing the complaint and the Department appealed.

The Appellate Division affirmed the lower court’s ruling, explaining that although a municipality "is immune from negligence claims arising out of the performance of its governmental functions unless the injured person establishes a special relationship with the municipality which would create a special duty of protection with respect to that individual," a special relationship may be formed "when a municipality voluntarily assumes a special duty that generates justifiable reliance by the person who benefits from the duty."

In order to demonstrate such a special duty, a plaintiff must show: "(1) an assumption by the municipality, through promises or actions, of an affirmative duty to act on behalf of the party who was injured, (2) knowledge on the part of the municipality's agents that inaction could lead to harm, (3) some form of direct contact between the municipality's agents and the injured party, and (4) the injured party's justifiable reliance on the municipality's affirmative undertaking."

In this instance, said the court, the Department failed to establish its prima facie entitlement to judgment as a matter of law, because it "failed to eliminate triable issues of fact" as to whether it assumed a special duty with respect to Morgan-Word.

Accordingly, the Appellate Division ruled that Supreme Court properly denied its motion for summary judgment.

The decision is posted on the Internet at:

http://www.courts.state.ny.us/reporter/3dseries/2012/2012_05151.htm

Broad arbitration clause precludes judicial interpretation of a collective bargaining agreement where “public policy” is not at issue

Broad arbitration clause precludes judicial interpretation of a collective bargaining agreement where “public policy” is not at issue
City of Utica v Teamsters, Chauffeurs, Warehousemen & Helpers Local Union 182, 21 Misc 3d 1109(A), Affirmed by the Appellate Division, 41 AD3d 1232

The Teamsters filed a contract grievance alleging that a member of the collective bargaining unit had been terminated by the City “without just cause” and in violations of the “progressive discipline” procedures set out in the relevant collective bargaining agreement. When Utica rejected its demand for arbitration, the Teamsters sued seeking a court order compelling arbitration; the City resisted, contending that the employee in question was “on probation” and thus an “employee-at-will.” Justice Hester said that a “Court's analysis in this matter is governed by …. §7501 [of the CPLR which] provides that "[i]n determining any matter arising under this article, the court shall not consider whether the claim with respect to which arbitration is sought is tenable, or otherwise pass upon the merits of the dispute."

Accordingly, a court's role in reviewing applications to stay arbitration is a limited one and it is not the Court's role to interpret substantive provisions of the contract or to pass on the merits of the dispute.

In this matter neither party contended that submitting the issue to arbitration implicates a “public policy” issue. Accordingly, the question as to whether arbitration was authorized because “the parties did agree by the terms of their particular arbitration clause to refer their differences in this specific area to arbitration."

Noting that there was a “broad arbitration clause” set out in the collective bargaining agreement, Justice Hester concluded that each of the objection raised by the parties such as the City’s claim that this particular grievance is not arbitrable and the Teamsters’ claim that Utica violated “past practice” was a contract interpretation and thus issues for the arbitrator to resolve.

In addition, Justice Hester pointed out that the City’s claim that the grievance was untimely filed was also an issue involving contract interpretation and thus ripe for an arbitrator to decide.

Indicating that “it is not the Court's duty to examine the scope of the substantive provisions of the contract to determine whether this particular grievance falls within the scope” of the collective bargaining agreement, Justice Hester denied the City’s petition seeking a stay of the arbitration.

The full text of the decision is posted on the Internet at:
http://www.nycourts.gov/reporter/3dseries/2006/2006_52623.htm

Failure to properly supervise juveniles in her care

Failure to properly supervise juveniles in her care

OATH Index No. 728/12

A juvenile counselor responsible for supervising teenagers incarcerated in a special support dorm lost track of a girl, leaving the teen unattended for a half-hour, and failed to take a proper headcount of the girls in her charge.

Although the girl was not harmed, OATH Administrative Law Judge Joan R. Salzman recommended an 18-day suspension, noting that keeping count of the juveniles under her supervision was the most important duty of employee’s job, and that she had previously made a similar mistake. 

The decision is posted on the Internet at:  

Admin. for Children’s Services v. Matos-Miranda(in PDF)

Supreme Court rules on the Patient Protection and Affordable Care Act

Supreme Court rules on the Patient Protection and Affordable Care Act

National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services, et al., United States Supreme Court, Docket #11-393

In 2010, Congress enacted the Patient Protection and Affordable Care Act, [124 Stat. 119]. The Act’s purpose was to in­crease the number of Americans covered by health in­surance and decrease the cost of health care. While the Act’s 10 Titles run over 900 pages and contain hundreds of provisions, the National Federation case concerned constitutional challenges to two key provisions, usually referred to as the Individual Mandate and the Medicaid Expansion.

In a ruling almost 200 pages in length,*including dissents, the majority first indicated that it did not consider whether the Act embodies sound policies, commenting that “That judgment is entrusted to the Nation’s elected leaders.” It characterized the question for it to address in this action as “Does Congress have the power under the Constitution to enact the challenged provisions?”

Essentially the Act’s “Individual Mandate” requires most Americans to maintain “minimum essential” health insurance coverage. It excludes some individuals, such as prisoners and undocumented aliens from this mandate. While many individuals are expected to obtain the required insurance through their employer or under a government pro­gram such as Medicaid or Medicare, individuals who are not exempt and who do not receive health insurance through a third party are required to purchase insurance from a private company.

Beginning in 2014, individuals required to purchase insurance from a private company that fail to do so would make a “[s]hared responsibility payment” to the Federal Government calculated as a percentage of household income, subject to a floor based on a specified dollar amount and a ceiling based on the aver­age annual premium the individual would otherwise have to pay for qualifying private health insurance.

As to Congress’ authority under the Commerce Clause to enact such legislation, the court ruled: "The commerce power ... does not authorize the mandate.”

However, said the court, “Neither the Act nor any other law attaches negative legal consequences to not buying health insur­ance, beyond requiring a payment to the IRS.”

Thus, the Affordable Care Act’s requirement that certain in­dividuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Be­cause the Constitution permits such a tax, it is not [the Supreme Court’s role] to forbid it, or to pass upon its wisdom or fairness.”

* Chief Justice Roberts announced the judgment of the Court and delivered the opinion of the Court with respect to Parts I, II, and III–C, in which Justices Ginsburg, Breyer, Sotomayor, and Kagan, joined; an opinion with respect to Part IV, in which Justices Breyer and Kagan, joined; and an opinion with respect to Parts III–A, III–B, and III–D. Justice Ginsburg, filed an opinion concurring in part, concurring in the judgment in part, and dissenting in part, in which Justice Sotomayor, joined, and in which Justices Breyer and Kagan, joined as to Parts I, II, III, and IV. Justices Scalia, Kennedy, Thomas, and Alito filed a dissenting opinion. Justice Thomas filed a dissenting opinion.

The Syllabus [prepared by the Reporter of Decisions for the convenience of the reader] and the Opinions of the Court are posted on the Internet at:

http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf