Waiting 19 Months to Seek Medical Treatment Proves Fatal to NY Claims Examiner’s Case
A New York appellate court affirmed a decision by the state’s Workers’ Compensation Board that denied benefits to a claims examiner who alleged that she had sustained injuries to her shoulder in a work-related fall at her office, but waited 19 months before seeking medical treatment [Matter of Richman v. New York State Workers' Compensation Bd., 2021 N.Y. App. Div. LEXIS 6429 (3d Dept. Nov. 18, 2021)]. Noting that claimant had preexisting physical issues, that she had waited some seven months before filing her workers’ compensation claim, and had failed to offer medical evidence as to causation beyond the introduction of her physician’s treatment notes and workers’ compensation medical forms, which the Board found cursory and inadequate to show causation, the court said substantial evidence supported the Board’s findings.
Background
Claimant, a claims examiner, filed a claim for workers’ compensation benefits on July 25, 2018, asserting that she sustained, among other injuries, a work-related injury to her right shoulder in a fall at work on January 19, 2018. Claimant first sought medical treatment on August 27, 2019, 19 months after the incident. The employer and workers’ compensation carrier controverted the claim contending, among other things, that there was no causal relationship between claimant’s condition and her employment and that her condition was not the result of a compensable accident. Following a hearing, a WCLJ established the claim for a work-related injury to claimant’s right shoulder. The Board reversed, finding that claimant had failed to submit sufficient, credible medical evidence to demonstrate that she sustained a casually-related injury to her right shoulder at work. Subsequently, the Board denied claimant’s application for reconsideration and/or full Board review. Claimant appealed from all three Board decisions.
Appellate Court Decision
Initially noting whether a compensable accident had occurred was a question of fact to be resolved by the Board and that the Board’s determination would not be disturbed when supported by substantial evidence, the appellate court reviewed relevant testimony offered by claimant. It noted that she had testified that she fell upon arrival at work while walking toward her desk, before any coworkers arrived, and did not seek any medical care for more than 19 months because she “was busy.” The court noted claimant’s testimony that at the time of her fall, she had been using a walker or cane due to preexisting injuries. It observed that claimant filed a C-3 form seven months later, a delay she could not explain.
To establish a causal relationship, claimant relied upon the office notes of, and workers’ compensation forms completed by, her treating physician, who did not testify or submit a medical report. According to the physician’s August and September 2019 office notes and forms, he diagnosed claimant with “primary osteoarthritis” to her right shoulder, “[r]ight shoulder pain with arthritis,” “slight restriction” in rotation and “sprain of right rotator cuff capsule, subsequent encounter.” The physician also noted “arthritic change” and “minimal degenerative change” and ruled out a fracture or dislocation.
The appellate court concluded that the physician’s brief notations merely established that claimant reported a fall at work and did not describe the fall with any precision or explain how her diagnoses were caused by the fall. Moreover, although the physician diagnosed arthritis and a degenerative condition, he did not state how or if the fall caused or exacerbated such conditions. The court found that given the limited evidence, substantial evidence supported the Board’s rejection of claimant’s medical proof as insufficient and not credible, and the Board’s decision that claimant failed to establish a causal relationship would not be disturbed.