The New York State Workers’ Compensation Board recently issued a decision in Matter of Jacobi Med. Ctr., No. 00825967, 2019 WL 645558 (N.Y. Work. Comp. Bd. Feb. 11, 2019) ruling that a claimant is only entitled to benefits for the duration of the capped period, regardless of surgeries subsequent to the time of classification.
In this case, the claimant was classified pursuant to a February 8, 2012 decision at a 50 percent loss of wage earning capacity, entitling the claimant to 300 weeks of benefits. Subsequently, the claimant underwent two back surgeries and periods of awards were increased to the total rate. On October 24, 2017, the carrier suspended payments as the capped period had run. However, the workers’ compensation law judge ruled that the claimant was entitled to awards beyond that 300-week period arguing that the periods of total disability for the surgeries did not apply against the cap. Additionally, since the carrier had an IME giving a marked disability, the claimant had a change in medical condition and was entitled to reclassification.
The full board disagreed and ruled that the claimant was only entitled to the 300 weeks of capped benefits under WCL Section 15(3)(w). The full board noted that the intent of the statute is to limit the duration of benefits for a permanently partially disabled claimant by capping benefits at a fixed number of weeks based upon the loss of wage earning capacity. The full board further noted, “there is nothing in the statute to suggest that any temporary increase in the degree of claimant’s disability that might occur after the date of classification should be considered to be additional weeks of benefits that would ultimately result in an increase in the overall total capped weeks.” Additionally, the Full Board ruled that in order for a claimant to be reclassified, the claimant must make such a request before the capped periods run out.
The significance of this case is that it protects carriers against potential liability exceeding the capped period of time. Subject to any further appeals, claimants who undergo medical procedures after classification, which would otherwise increase their benefits due to an increase in medical disability, can no longer collect awards exceeding the capped period under WCL § 15(3)(w).