Three Recent NY Appellate Cases Remind Us Why Workers’ Compensation Claims Are Rarely Simple

Here is a look at a few recent New York Appellate Division workers’ compensation cases.

Alexander v. NYC Dept. of Homeless Services, Third Dept. Decided 9/17/26

The Appellate Division agreed with the Board Panel finding that a claimant did not qualify for total permanent disability based on his morbid obesity. Here, the claimant injured his left hip, left knee, and back in April 2020. The Third Department found that a claimant’s non-work related morbid obesity, where he is confined to a motorized scooter, was a significant contributing factor to his physical limitations. That, and evidence the claimant was capable of sedentary employment, was enough to support the Board’s ruling.

Rosario v. The William Carter Company, Third Dept. Decided 9/17/26

The Third Department upheld a Board Panel decision finding that a compensable accident occurred despite CCTV footage showing a different version of events. The claimant was an Assistant Manager for a retail store when she claims a box fell and hit her left leg. There was actual video of the scene, and it showed a “box drops near her left leg” [emphasis added]. Because the Law Judge believed that she “react[ed] in a manner consistent with being struck by [the box],” that was sufficient to establish the case. In part, the Board used the Carrier’s independent medical examiner (IME) doctor’s opinion that there was a causal relationship. So, even when you have video that demonstrates not being struck, the Board still found for the claimant and the Appellate Division would not reverse it. This is another example of why it is important to evaluate whether it is in the best interest of the defense to have an IME on causal relationship at all, particularly when there is contradictory non-medical evidence upon which a defense is based.

Loja-Saula v. Cosan Construction Corp., Third Dept. Decided 8/20/26.

The Appellate Division affirmed a Board Panel decision finding no fraud pursuant to Sec. 114-a. Here, the law judge at the trial found there was a violation, but the Board Panel overturned the decision. The issue was whether the claimant’s failure to notify the carrier of at least two Insurance Services Office (ISO) hits for previous claims rose to a Sec. 114-a violation. Ultimately, the Board Panel found that the ISO report itself was flawed. There were slightly different names and different home addresses. And, one of the hits was for an “unspecified” injury that was inconclusive as it related to the body parts here. There were 11 other matches on the ISO report with slightly different dates of birth or different addresses. Importantly here, there does not appear to be any corroborating evidence with actual documentation from the claims noted in the ISO report. Perhaps, had those been presented with evidence of the injuries to this claimant to the same body parts, that may have made a difference. This is another reason why it is important to get medical records from prior claims, particularly when there is some reasonable basis to believe there are prior claims.