Clarifying the Evidentiary Standard for Permanent Total Disability under New York Workers’ Compensation Law

1. Introduction

Matter of Serrano v. Bay Park Center for Nursing & Rehabilitation (2025 NYSlipOp 01844) presents an important decision by the Appellate Division, Third Department, on the burden of proof required to establish a permanent total disability (PTD) under New York’s Workers’ Compensation Law. Jaime Serrano, a former housekeeping employee, suffered injuries to his left shoulder and lower back in 2014. After rotator cuff surgery and follow-up treatment, the claim was amended to include consequential depression. The key issues on appeal are:

Whether Serrano proved by credible medical evidence that he is totally and permanently disabled from any gainful employment;
Whether the Workers’ Compensation Board properly weighed conflicting medical opinions;
Whether Serrano’s application for reconsideration/full Board review should have been granted.

The respondents include Bay Park Center for Nursing & Rehabilitation and its workers’ compensation carrier (Oriska Insurance Company), with the Workers’ Compensation Board as an additional respondent on review.

2. Summary of the Judgment

The Appellate Division affirmed two Board decisions. The first found that Serrano had not sustained a permanent total disability as a matter of law due to insufficient credible medical evidence. The Board credited medical opinions establishing that Serrano retained the capacity for some form of work—most notably sedentary or light-duty assignments—despite his persistent symptoms. The second decision denied Serrano’s application for reconsideration/full Board review, concluding he failed to present new evidence, demonstrate a material change in condition, or show that the Board overlooked any issues in its initial determination.

3. Analysis

3.1 Precedents Cited

Matter of Jennings v. Stop & Shop (210 AD3d 1272 [3d Dept 2022], lv denied 39 NY3d 911 [2023]): Defined the four disability classifications—PTD, temporary total disability, permanent partial disability, and temporary partial disability.
Matter of Williams v. Preferred Meal Sys. (126 AD3d 1259 [3d Dept 2015]): Held that PTD requires medical proof demonstrating an inability to engage in any gainful employment.
Matter of Burgos v. Citywide Central Ins. Program (148 AD3d 1493 [3d Dept 2017], aff’d 30 NY3d 990 [2017]): Reaffirmed the definition and burden of proof for PTD under WCL § 15.
Rubeis v. Aqua Club, Inc. (3 NY3d 408 [2004]): Clarified that attachment to the labor market is a distinct inquiry when evaluating PTD claims.
Matter of VanDermark v. Frontier Ins. Co. (60 AD3d 1171 [3d Dept 2009]): Confirmed that the Board has discretion to weigh conflicting medical evidence.
Matter of Villagil v. Sauce Pizzeria III, LLC (222 AD3d 1154 [3d Dept 2023]): Outlined the standards for granting reconsideration or full Board review.

3.2 Legal Reasoning

The Court’s decision centers on two principles: (1) the statutory definition of PTD under Workers’ Compensation Law § 15(1), which requires total and permanent inability to work; and (2) the Board’s exclusive province to resolve conflicts in medical testimony if that testimony qualifies as substantial evidence.

Medical Evidence Weighed:

Carrier’s expert psychiatrist, Dr. Gregory Brown, found Serrano incapable of full-time, part-time, or light-duty work but classified his depressive condition as a 75% permanent partial disability.
Claimant’s treating psychologist, Dr. Juraci DaSilva, assigned an 85% permanent partial psychological impairment.
Orthopedic surgeon Steven Renzoni and treating physiatrist Dr. Imelda Cruz-Banting concluded Serrano could engage in sedentary work with restrictions, diagnosing only a schedule loss of use in the shoulder and a class 2, level A soft-tissue spine condition.

The Board credited the opinions supporting residual work capacity, noting Serrano had not sought treatment for more than a year—a fact it deemed inconsistent with claims of total incapacity. Because substantial evidence supported the Board’s credibility determinations and ultimate finding against PTD, the Appellate Division declined to disturb the decision.

3.3 Impact of the Decision

This ruling reinforces several important takeaways for future workers’ compensation claims:

PTD claims demand unequivocal medical proof that the claimant cannot engage in any gainful employment.
The Board’s role as the factfinder permits it to resolve conflicting expert opinions, provided those opinions constitute substantial evidence.
Claimants should maintain consistent treatment records; gaps may undermine claims of total disability.
Reconsideration or full Board review applications must present new evidence, a material change in condition, or clear oversight by the Board.

4. Complex Concepts Simplified

Maximum Medical Improvement (MMI): The point at which a claimant’s condition is stable and unlikely to improve further with additional medical treatment.
Schedule Loss of Use: A fixed-percentage impairment rating for specific body parts (e.g., a shoulder or arm) that translates into compensation under a statutory schedule.
Permanent Total Disability (PTD): A condition in which a claimant is permanently unable to engage in any gainful employment due to work-related injury.
Labor Market Attachment: An assessment of whether a claimant retains the capacity and opportunity to obtain and maintain employment consistent with his restrictions.

5. Conclusion

Matter of Serrano v. Bay Park Center clarifies that the burden of proof for permanent total disability in New York requires clear, credible medical evidence demonstrating total inability to work. The decision underscores the Board’s authority to weigh expert testimony and the importance of consistent treatment records. By affirming the standards set forth in Jennings, Williams, and other precedents, this case will guide practitioners and claimants in framing and presenting PTD claims and in gauging the viability of applications for reconsideration or full Board review.