NY Claimant Must Show Causal Connection Between Employment and Medical Condition Even When Employer Fails to Controvert Claim

While an employer's failure to file a timely notice of controversy precludes the employer from submitting evidence that the claimant did not sustain accidental injuries or that the alleged injuries did not arise out of and in the course of her employment [see N.Y. Workers' Comp. Law § 25(2)(b)], it does not relieve the claimant from her burden to demonstrate a causal relationship between her employment and her medical condition, held a New York appellate court in Matter of Wen Liu v. Division of Gen. Internal Medicine, Mount Sinai Sch. of Medicine, 2020 N.Y. App. Div. LEXIS 4985 (Sept. 3, 2020).

Accordingly, where claimant's description of the events surrounding her injury provided to her medical experts different substantially from what she told emergency healthcare providers just after the incident, the Board could find claimant failed to establish the requisite connection between the employment and her claimed medical condition.

Background

In May 2010, claimant, a data programming analyst, filed a claim for workers' compensation benefits claiming that she had sustained an injury to her neck on June 5, 2008, when she fell at work after becoming dizzy. Claimant was later found to have provided prima facie evidence of injuries to her head and neck, and carpal tunnel syndrome in the left wrist. The employer failed to file a timely notice of controversy and, therefore, was precluded from submitting evidence that claimant did not sustain accidental injuries or that the alleged injuries did not arise out of and in the course of her employment. A WCLJ nevertheless found that claimant had not demonstrated a causal connection between her injuries and her employment and disallowed the claim. The Board upheld the determination, and claimant appealed.

Appellate Court Decision

Initially, the Court noted that in order to establish her claim for benefits, claimant bore the burden of demonstrating, by competent medical evidence, that a causal connection existed between her injuries and her employment. She bore that burden in spite of the fact that the employer had not filed a timely notice of controversy.

The Court observed that claimant's medical experts concluded that she suffered from neck, head and wrist injuries causally related to the 2008 fall at work, but that the opinions were not reached until after claimant had filed her claim and were based upon claimant's description of the incident, which included that she had struck her head on a wall and her wrist on a chair during the fall and had lost consciousness. The Court stressed, however, that the emergency room records indicated, both on the day of the incident and at subsequent visits in the days following, that claimant reported no loss of consciousness and reflected that she complained about feeling weak and dizzy, with no mention of striking her head or wrist during a fall, and no complaints of head or neck pain or injury. The ER records also reflected that claimant indicated that she had suffered from chronic left arm numbness and neck pain for more than five years.

Given the foregoing, the Court said substantial evidence supported the Board's rejection of claimant's medical proof as unworthy of belief, and its decision that claimant was not injured in a work-related accident on June 5, 2008 would not be disturbed.