The Workers’ Compensation Board has sole jurisdiction over issues related to eligibility for WC Benefits

In an action for recovery of No-Fault benefits, any question as to the injured party’s eligibility for Workers’ Compensation benefits must be decided by the Workers’ Compensation Board.

B.Y., M.D., P.C. v. Global Liberty Ins. Co. of N.Y., 2012 NY Slip Op 50156(U) (App. Term, 2nd Dept. 1/24/2012)

The Appellate Term held that upon plaintiff’s motion for summary judgment and defendant’s motion for same, the defendant raised a question of fact as to whether the plaintiff’s assignor’s injuries occurred in the course of his employment, thereby entitling him to workers’ compensation benefits. Such a question must be determined by the Workers’ Compensation Board and the court therefore remitted the matter to the Suffolk County District Court for a determination of the motion following a prompt application to the Board for a determination as to the parties’ rights under the Workers’ Compensation Law. The Appellate Term further ordered that the plaintiff’s failure to file proof of such application with the District Court within 90 days would result in dismissal of the action.

A.B. Med. Servs., PLLC v. American Tr. Ins. Co., 34 Misc 3d 141(A)(App. Term, 2nd Dept. 1/17/2012)

In this action for No-Fault benefits, the plaintiff moved for summary judgment and the defendant cross-moved for dismissal based on the assignor’s eligibility for workers’ compensation benefits, arguing that the matter must be submitted to the Workers’ Compensation Board to determine whether the assignor’s injuries occurred in the course of his employment. The District Court denied the plaintiff’s motion and granted the defendant’s cross-motion, dismissing the complaint and finding that the matter should be referred to the Board for a determination regarding the assignor’s eligibility for workers’ compensation benefits. Thereafter, the plaintiff moved to renew its prior motion based on its allegation that the Board was unable to consider the matter because the plaintiff’s assignor had failed to file a claim with the Board. The District Court granted the plaintiff’s motion to renew its prior motion for summary judgment and upon renewal, granted the plaintiff’s motion for summary judgment.

On appeal, the Appellate Term reversed the order of the Nassau County District Court granting renewal and summary judgment to the plaintiff and held that the documents offered by the plaintiff in support of its motion to renew, specifically letters to and from the Board attempting to schedule a hearing regarding the assignor’s eligibility for benefits did not constitute “new evidence” warranting renewal of the prior motion for summary judgment. The Appellate Term further noted that “contrary to the conclusion of the District Court, it is the Board which has primary jurisdiction to resolve the question of coverage.”

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