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Reopening of Claim Barred Transfer of Liability to Special Fund:



A New York appellate court ruled that the Special Fund for Reopened Cases was not liable for the benefits being paid to a worker for a 2003 accident because the worker's 2003 claim was effectively reopened in 2009 when a doctor apportioned liability for the worker's disability between the 2003 injury and a 2009 injury.


Case: Matter of Korthals v. Valu Home Centers, No. 516810, 12/05/2013, published.


Facts: Kathleen Korthals suffered an injury to her back while working for Valu Home Centers in August 2003. She received an award of workers' compensation benefits for this injury for the period from August 2003 to December 2003.


Korthals injured her back again in 2009, while working for Spectrum Human Services, and a new claim for workers' compensation was established.


An independent medical examiner evaluated Korthals in September 2009 and opined that her condition at that point should be apportioned 50% to the 2009 injury, 25% to the 2003 injury and 25% to injuries that Korthals suffered in two motor vehicle accidents that occurred between 1999 and 2001.


In 2011, Korthals underwent back surgery, and in 2012, Spectrum's workers' compensation carrier filed a request for further action, raising the issue of apportionment with the 2003 claim.


Valu's workers' compensation carrier then sought to shift liability for the 2003 claim to the Special Fund for Reopened Cases, and the Workers' Compensation Board transferred liability to the Special Fund.


Analysis: The Appellate Division's 3rd Department explained that under New York law, liability for a claim shifts to the Special Fund where a workers' compensation case that was fully closed is reopened more than seven years after the underlying injury occurred and more than three years after the last payment of compensation.


The court said that the filing of a medical report in a claim that apportions liability to a prior claim will constitute an application to reopen the prior claim. Since the medical report apportioning 25% liability to the 2003 claim was submitted to the Board in September 2009, within seven years of the date of the injury underlying that claim, the court said the Board's determination that there had not been a request to reopen the 2003 claim within seven years of the underlying injury is not supported by substantial evidence and, therefore, liability for the claim should not have been transferred to the Special Fund.


Disposition: Reversed and remitted.


To read the decision, click here.



Source: WorkCompCentral

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