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Third Deparment Decision: Disputing Causal Relationship

by | Jun 28, 2021 | MAD News, NYS Workers Compensation |

At LOMAD, we monitor the Third Department for case law updated to stay on the cutting-edge of workers’ compensation law in New York. This month we noted an interesting decision in Allen v. CPP-Syracuse, that provides a helpful reminder to all of us when we are disputing causal relationship.

Allen v CPP–Syracuse, 2021 N.Y. Slip Op. 03226 (3d Dept., May 20, 2021)

Decision Below: claimant’s generalized anxiety disorder was consequential to his established claim for injuries to his left shoulder and neck.

Affirmed: The Third Department affirmed the Board’s decision to uphold the establishment of consequential anxiety where the IME doctor and the treating doctor found causal relationship. The carrier argued that their causal relationship opinions should not stand in support of establishment as they did not account for claimant’s treatment records relating to a prior MVA. However, these treatment records were not in the Board file and, while carrier applied to reopen the case to get them put into the Board file, the Board denied their application as they knew about the records for some time and thus did not meet the “within a reasonable time after the applicant has had knowledge of the facts” standard. Therefore, the Third Department agreed with the Board that, where the doctors reviewed claimant’s medical records in the Board file and met with the claimant, the Board’s decision to establish consequential anxiety was supported by substantial evidence.

This decision is significant, in light of recent Third Department case law that we use to dispute doctors’ opinions on causal relationship. Critically, the Third Department requires physicians to have a complete and accurate understanding of the history of the accident and the claimant’s medical records and history before making an opinion in a workers’ compensation case. See Fox v. Altmar, –Parish–Williamstown Central School District, 175 A.D.3d 1728, 1729-1730 (3d Dept. 2019) (finding the doctor’s opined causal relationship insufficient to establish the employee’s claim where the doctor did not personally examine the claimant and, most importantly, did not examine claimant’s prior medical records); see also Matter of Johnson v. Borg Warner, 186 A.D.3d 1772, 1773 (3d Dept. 2020) (finding claimant’s medical evidence insufficient to support a claim for an allegedly causally-related meniscal tear where the doctor testified that it is “very reasonable that something could have happened at work that exacerbated a chronic condition” or that there was a “strong possibility” that the claimant suffered an acute meniscal tear).

Thus, what Allen show us, is that we need to remain vigilant of potentially relevant medical records that predate the date of accident, as we need to quickly obtain them and submit them to the Board file to preserve our argument that a doctor’s causal relationship opinion cannot stand due to the doctor’s incomplete or inaccurate understanding of the claimant’s medical history.

For more updates on developments in New York workers’ compensation law, stay tuned to our NY WC Blog, please join the New York Workers’ Compensation Forum on LinkedIn, and attend our monthly webinar series, LOMAD & Friends, on the fourth Friday of every month!