Inconsistent Evidentiary Preclusion by the Workers’ Compensation Board Requires Reversal and Remittal in § 21 Presumption Death Claims

Case: Matter of Hanson v General Elec. Co., 2025 NY Slip Op 01409 (App Div 3d Dept Mar. 13, 2025)
Tribunal Reviewed: Workers’ Compensation Board
Disposition: Reversed; matter remitted for further proceedings

1. Introduction

This decision arises from a claim for workers’ compensation death benefits following the on-site collapse and death of a field service technician while repairing a refrigerator at a customer’s residence. The decedent’s death certificate listed acute aortic dissection due to hypertension, with emphysema as a contributing condition.

The core dispute was causation: whether the death was work-related under the statutory presumption for unwitnessed or unexplained workplace deaths, and—once rebuttal evidence was produced—whether the claimant could prove work-related causation through admissible medical proof. The litigation also turned on procedure: whether the Board could preclude claimant’s medical reports for lack of an express direction to submit them, and then deny further opportunity to submit proof on the ground that claimant had already been given “ample opportunity.”

Parties: Donna Hanson (claimant/appellant), General Electric Company and its carrier (respondents), and the Workers’ Compensation Board (respondent).

2. Summary of the Opinion

The Appellate Division, Third Department held that the carrier’s medical evidence was sufficient to rebut the Workers’ Compensation Law § 21 presumption of compensability, thereby shifting the burden back to claimant to prove causal relationship. However, the Court reversed the Board’s ultimate disallowance of the claim because the Board’s handling of claimant’s medical proof was internally inconsistent and partly based on an inaccurate understanding of the record.

Specifically, the Board precluded claimant’s medical opinion evidence on the rationale that claimant had not been “directed” by the Board to submit additional record review reports (following the Board’s preclusion of an earlier report), yet later concluded that claimant had been given “ample opportunity” to produce medical evidence and denied further opportunity. The Court found this contradiction—combined with the Board’s erroneous belief that a particular report had already been precluded—required reversal and remittal for further proceedings.

3. Analysis

3.1 Precedents Cited

The Court’s analysis rests on two lines of precedent: (1) the operation of the § 21 presumption in unwitnessed/unexplained death cases and the standard for rebutting it; and (2) appellate intervention when the Board’s reasoning is inconsistent or reflects a misreading of the record.

  • Matter of Polonski v Town of Islip, 220 AD3d 1031 (3d Dept 2023), lv denied 41 NY3d 905 (2024):
    Cited for the rule that when an unwitnessed or unexplained death occurs during the course of employment, the § 21 presumption applies and “obviates the need” for prima facie medical proof at the outset. This case frames the threshold: the claimant begins with a procedural advantage, but it is rebuttable.
  • Matter of Frederick v Lindenhurst Union Free School Dist., 66 AD3d 1104 (3d Dept 2009):
    Quoted for the rebuttal standard: substantial evidence can rebut the presumption, and rebuttal does not require “irrefutable proof excluding every conclusion other than that offered” by the employer/carrier. This is important because it lowers the employer’s rebuttal burden below certainty; credible medical opinion attributing death to nonwork risk factors can suffice.
  • Matter of Rasiej v Syska Hennesy Group Inc., 145 AD3d 1332 (3d Dept 2016):
    Reinforces the Frederick standard that rebuttal need only be supported by substantial evidence, not absolute exclusion of work causation.
  • Matter of Puig v New York Armenian Home, Inc., 65 AD3d 1444 (3d Dept 2009):
    Cited for burden shifting: once the employer rebuts § 21, the burden returns to claimant to prove causation.
  • Matter of Kaplan v New York City Tr. Auth., 178 AD3d 1262 (3d Dept 2019):
    Used both for the burden-shift proposition and for application: once rebuttal is established, claimant must come forward with competent evidence of causal relationship.
  • Matter of Lavigne v Hannaford Bros. Co., 153 AD3d 1067 (3d Dept 2017):
    Cited as additional support that carrier medical proof can rebut § 21 and shift the burden back to claimant.
  • Matter of Gullo v Wireless Northeast, 160 AD3d 1106 (3d Dept 2018):
    Cited for the appellate court’s willingness to reverse and remit where the Board’s determination is undermined by flawed reasoning or procedural inconsistency affecting fairness and record development.
  • Matter of Epsaro v Buffalo Bd. of Educ., 67 AD3d 1118 (3d Dept 2009):
    Similarly supports remittal where the Board’s decision-making process is compromised—here, by inconsistency and reliance on an inaccurate reading of the record.

3.2 Legal Reasoning

(a) Rebuttal of the § 21 presumption. The Court first addressed claimant’s argument that the carrier failed to rebut compensability. The carrier’s cardiologist, Dr. Sumner, attributed the aortic dissection to nonwork factors (longstanding hypertension and smoking), and opined that moving a wheeled refrigerator would not have caused the dissection. Under Matter of Frederick v Lindenhurst Union Free School Dist., this type of medical opinion can constitute “substantial evidence” sufficient to rebut the presumption even if it does not rule out all alternative possibilities. The Court therefore held the presumption was rebutted, shifting the burden to claimant.

(b) Claimant’s post-rebuttal burden and the evidentiary bottleneck. Once the burden returned to claimant, claimant needed admissible medical proof linking the death to work exertion/stress. Claimant attempted to supply that proof through record-review reports, but the case became dominated by regulatory compliance and procedural rulings:

  • The WCLJ precluded Dr. Stern’s report based on alleged noncompliance with 12 NYCRR 300.2 (d) (4) (iv) (service requirements).
  • Claimant then obtained Dr. Basri’s report. An initial report lacked a signed certification required by 12 NYCRR 300.2 (d) (4) (i) (e); an amended report added the certification.
  • The WCLJ admitted Basri’s amended report and credited it to establish causation.
  • The Board later precluded Basri’s report and testimony on the theory that allowing additional record reviews without a Board “direction” would “defeat” its earlier preclusion of Stern.

The Appellate Division did not (in this opinion) definitively resolve the underlying regulatory admissibility issues in the abstract. Instead, it focused on the Board’s internal inconsistency and record error in applying its own procedural rationale, which undermined the fairness and rationality of the adjudication after the burden had shifted back to claimant.

(c) The Board’s contradiction and misreading required reversal. Two defects drove the Court’s reversal:

  • Contradictory procedural posture: The Board precluded claimant’s medical evidence because claimant lacked a Board “direction” to submit it, yet later reasoned that claimant had “ample opportunity” to produce medical evidence and denied another opportunity. The Court found these positions incompatible: if claimant was barred for lack of authorization, the record cannot simultaneously support a finding that claimant had a fair, adequate opportunity to submit proof.
  • Inaccurate record premise: The Board also relied on an “erroneous belief” that the WCLJ had already precluded Basri’s February 2018 report, a belief the Court stated had “no support in the record.” Reliance on a mistaken factual predicate further undermined the Board’s determination.

Because these errors infected the Board’s analysis of claimant’s ability to meet the post-rebuttal burden, the Court reversed and remitted for further proceedings “not inconsistent” with its decision—signaling that the Board must reevaluate evidentiary handling and the claimant’s opportunity to present medical causation proof under a coherent, record-accurate framework.

3.3 Impact

The decision’s most significant practical impact is procedural: it constrains the Board from using evidentiary preclusion in a way that both (i) prevents a party from curing or replacing excluded proof absent an express “direction,” and (ii) later penalizes that party for failing to produce proof by declaring that ample opportunity was already afforded. In § 21 presumption cases—where the burden can shift quickly upon carrier rebuttal—this ruling reinforces that the Board must manage record development consistently and accurately, particularly when its own evidentiary rulings create the absence of proof.

More broadly, the decision underscores appellate readiness to intervene when administrative decision-making reflects internal contradiction or reliance on facts not supported by the hearing record. Future litigants can be expected to cite this case when challenging Board decisions that: (1) preclude key medical evidence on technical grounds, (2) refuse supplementation or correction, and (3) then deny the claim for want of medical proof.

4. Complex Concepts Simplified

  • Workers’ Compensation Law § 21 presumption (unwitnessed/unexplained death).
    If a worker dies at work and the death is unwitnessed or unexplained, the law presumes the death is work-related. This helps claimants by not requiring immediate medical proof of causation at the outset.
  • Rebutting the presumption with “substantial evidence.”
    The employer/carrier can rebut the presumption by presenting enough credible evidence (often medical opinion) that the death was probably not work-related. They do not need to prove this beyond all doubt.
  • Burden shifting.
    Once rebutted, the presumption drops out and the claimant must prove—typically through admissible medical evidence—that work caused or contributed to the death.
  • “Record review” reports and technical admissibility rules (12 NYCRR 300.2).
    New York workers’ compensation procedure can require medical reports to be served correctly and include certifications/attestations. Noncompliance can lead to preclusion (the judge or Board refuses to consider the report).
  • Remittal.
    When the appellate court sends the case back to the Board for additional proceedings because the prior decision-making process was flawed.

5. Conclusion

Matter of Hanson v General Elec. Co. reaffirms orthodox § 21 principles: credible carrier medical evidence can rebut the presumption and shift the burden back to claimant. But the decision’s principal contribution is administrative-law in character: the Workers’ Compensation Board cannot preclude a claimant’s causation evidence on the ground that no Board “direction” authorized its submission, and then deny the claim by asserting the claimant had “ample opportunity” to submit proof—particularly where the Board’s analysis rests on a misreading of the record.

The key takeaway is that, once the presumption is rebutted, the Board must ensure a coherent and record-accurate process for developing (or limiting) medical evidence; otherwise, disallowance for “lack of proof” risks reversal and remittal.