For an accident to be covered under the Workers’ Compensation Law, an injured worker must show two things: that the accident happened while he or she was working, and that it happened because of the work. In some cases, often involving a death on the job, the accident is unwitnessed or unexplained. For those cases, the law includes a “presumption” that if the death occurred while the person was working, it was also caused by the work. While this does not necessarily guarantee a decision in the worker’s favor, it does two things: it relieves them of the obligation to produce a medical report in support of their case (at least at the outset); and it places an obligation on the employer or insurance company to show that the death was not due to the work.
In this case, a transit worker collapsed and died in the employer’s locker room after a day of heavy work. A WCL Judge properly applied the law and found that the employer had submitted no evidence showing that his death was unrelated to the work. The judge therefore awarded death benefits to our client, his widow.
The Transit Authority appealed and the Workers’ Compensation Board reversed the judge’s decision, finding that the presumption did not apply because of statements contained in medical records in another, unrelated, case for the deceased worker. We appealed this decision, arguing that the records the Board relied on were not sufficient to defeat the claim, and also that the Board was not entitled to review records from another file in deciding the case without any notice to our client.
The Appellate Division, Third Department agreed with our position and reversed the Board’s decision. The Court held that the Board failed to follow its own rules and that our client “was prejudiced because she was not on notice – until she received the Board decision – that the Board would rely on documents from another case file.”