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Smart Summary

Factual and Procedural Background

Claimant was employed as a salesperson from June 1991 until March 3, 1992, when he sustained a back injury from slipping on ice during work. His workers' compensation claim was established in July 1993, with his average weekly wage initially set at $447.36 based on a C-240 form filed by the employer. Over time, claimant was found to have a permanent partial disability and later a marked permanent partial disability. In 2007, claimant sought a determination of total industrial disability and requested recalculation of his average weekly wage under Workers' Compensation Law § 14, arguing it should reflect wages of a similar worker at the time of injury rather than his actual wages. The Workers' Compensation Law Judge (WCLJ) agreed, directing the employer to submit a C-240 form for a similar worker, but the employer was unable to do so due to limited payroll records. The WCLJ found claimant totally industrially disabled and modified his average weekly wage to $624. The Workers' Compensation Board upheld these findings, and the employer and carrier appealed.

Legal Issues Presented

  1. Whether claimant is totally industrially disabled under the Workers' Compensation Law given his physical limitations and employment history.
  2. Whether the Workers' Compensation Board had jurisdiction to modify claimant's average weekly wage despite the absence of an appeal or application to reopen the 1993 wage determination.
  3. Whether the doctrine of laches barred claimant's delayed request to modify his average weekly wage.
  4. Proper method for calculating claimant's average weekly wage under Workers' Compensation Law § 14 when claimant did not work substantially all of the year preceding injury.

Arguments of the Parties

Appellants' Arguments

  • Claimant's total industrial disability finding was unsupported by substantial evidence and improperly favored the Board's vocational rehabilitation counselor over the employer's expert.
  • The Board lacked jurisdiction to modify the 1993 average weekly wage decision absent an appeal or application to reopen.
  • The doctrine of laches barred claimant's modification request due to an unreasonable delay causing prejudice, specifically the employer’s inability to provide payroll records of a similar worker.
  • The employer contended that the original wage setting was proper and that claimant's average weekly wage should not be recalculated.

Respondent's Arguments

  • Claimant is totally industrially disabled due to physical limitations compounded by limited education and work history, rendering him incapable of gainful employment.
  • The Board has continuing jurisdiction under Workers' Compensation Law § 123 to modify prior decisions as just.
  • The employer’s failure to provide accurate payroll data initially was a factor in the delay and prejudice argument, negating application of laches.
  • Claimant’s average weekly wage should be recalculated based on the wages of a similar worker or, if unavailable, on a reasonable representation of claimant’s earning capacity, here using his last 10 weeks of earnings.

Table of Precedents Cited

Precedent Rule or Principle Cited For Application by the Court
Matter of Barsuk v Joseph Barsuk, Inc., 24 AD3d 1118 Definition of total industrial disability including consideration of work-related limitations and other factors. Supported the Board's finding that claimant was totally industrially disabled based on physical limitations and employment history.
Matter of Guan v CPC Home Attendant Program, Inc., 50 AD3d 1218 Standard that total industrial disability is a question of fact for the Board, reviewable only for substantial evidence. Confirmed that the Board's factual determination would not be disturbed absent lack of substantial evidence.
Matter of Newman v Xerox Corp., 48 AD3d 843 Review of credibility and medical evidence conflicts as matters for the Board. Supported the Board’s discretion to resolve conflicting evidence in favor of claimant.
Workers' Compensation Law § 123 Board’s continuing jurisdiction to modify prior findings, awards, or decisions as just. Justified the Board's authority to modify claimant's average weekly wage despite delay and lack of appeal.
Matter of Bey v Aramark Healthcare Support Servs., Inc., 26 AD3d 607 Application of Board’s continuing jurisdiction under Workers' Compensation Law § 123. Supported the Board’s jurisdiction to amend prior wage findings.
Matter of Holloway v West St. Trucking, 14 AD3d 816 Application of laches doctrine in workers’ compensation context requiring unreasonable delay and prejudice. Used to reject employer’s claim of prejudice and support refusal to bar claimant’s wage modification.
Matter of Delmonte v Sears, Roebuck Co., 12 AD2d 548 Proper method for calculating average weekly wage for salesmen with commission-based income. Supported use of Workers' Compensation Law § 14(3) to determine a reasonable wage reflecting earning capacity.
Matter of Manticoff v American Bldg. Maintenance, 63 AD3d 1308 Substantial evidence standard for application of laches and wage modification. Confirmed Board’s factual findings would not be disturbed.
Matter of Utley v General Motors Corp., 285 AD2d 843 Deference to Board’s vocational rehabilitation counselor over employer’s conflicting expert. Supported rejection of employer’s contrary vocational evidence.
Matter of Yanarella v IBM Corp., 195 AD2d 620 Credibility and evidentiary conflicts are for the Board to resolve. Supported affirmance of Board’s credibility determinations.

Court's Reasoning and Analysis

The court first examined whether claimant was totally industrially disabled. Applying established precedent, the court recognized that total industrial disability may be found where a claimant’s work-related limitations, combined with other factors such as limited education and work history, render the claimant incapable of gainful employment. Claimant’s testimony about his severe physical limitations and the Board’s vocational counselor’s evaluation constituted substantial evidence supporting this finding. The employer’s conflicting evidence was deemed inconclusive, and the Board’s resolution of credibility conflicts was entitled to deference.

Regarding the modification of claimant’s average weekly wage, the court reaffirmed the Board’s continuing jurisdiction under Workers' Compensation Law § 123 to amend prior decisions as just, rejecting the employer’s argument that modification was barred absent appeal or reopening. The court also rejected application of the doctrine of laches, reasoning that although claimant delayed nearly 15 years in seeking modification, the employer’s initial erroneous wage reporting and failure to maintain adequate payroll records contributed to any prejudice. Moreover, the court found no real prejudice to the employer under the circumstances.

On the merits of wage calculation, the court applied Workers' Compensation Law § 14, which prescribes different methods for calculating average weekly wage depending on employment duration prior to injury. Since claimant did not work substantially all of the preceding year, his average weekly wage should not have been based on actual wages during his 39 weeks of employment. The court accepted the WCLJ’s rationale that claimant’s earnings in the last 10 weeks best reflected his earning capacity, but corrected the calculation to properly average the last 10 weeks rather than 11, resulting in a modified average weekly wage of $592.23.

The court reviewed other contentions by the employer and carrier and found them without merit.

Holding and Implications

The court modified the Workers' Compensation Board’s decision by reversing the amendment of claimant’s average weekly wage to $624 and instead set the average weekly wage at $592.23. In all other respects, the decision was affirmed.

The direct effect of this decision is that claimant is recognized as totally industrially disabled and entitled to a recalculated average weekly wage reflecting his true earning capacity at the time of injury. The decision underscores the Board’s continuing jurisdiction to modify prior wage determinations and limits the applicability of laches in cases where employer error contributed to delay or prejudice. No new precedent was established beyond the application of existing legal standards to the facts of this case.

In the Matter of the Claim of Duow SACCO, Respondent, v. MAST ADVERTISING/PUBLISHING et al., Appellants, et al., Respondent. WORKERS' COMPENSATION BOARD, Respondent.

Peters, J.P.Page 1305

Claimant worked as a salesperson for the employer from June 1991 to March 3, 1992, when he injured his back after slipping and falling on ice during the course of his employment. In July 1993, his claim for workers' compensation benefits was established and, based upon a C-240 form filed by the employer, his average weekly wage was set at $447.36. Claimant was initially found in March 1996 to have a permanent partial disability and was reclassified in October 2003 with a marked permanent partial disability.

In 2007, claimant sought a finding that he was totally industrially disabled and requested that his average weekly wage be recalculated pursuant to Workers' Compensation Law § 14, arguing that it should have been based on the wages of a similar worker at the time of his injury, rather than his actual wages. The Workers' Compensation Law Judge (hereinafter WCLJ) agreed and directed the employer to submit a C-240 form for a similar worker. In response, the employer indicated that, since it maintained payroll records for only seven years, no such records were available for an employee at the time of claimant's injury. Following a hearing, the WCLJ found claimant to have a total industrial disability and reserved decision on the issue of claimant's average weekly wage. In a decision filed in May 2008, a WCLJ found that the C-240 form filed by the employer in 1992 was "improper on its face," interpreted it in favor of claimant due to the employer's failure to submit a C-240 form reflecting the wages of a similar worker, and modified claimant's average weekly wage to $624 pursuant to Workers' Compensation Law § 14 (3). Upon the employer's appeal, the Workers' Compensation Board upheld both the March 2008 and May 2008 decisions. The employer and its workers' compensation carrier now appeal.

Substantial evidence supports the Board's determination that claimant suffers a total industrial disability. "A claimant who has a permanent partial disability may nonetheless be classified as totally industrially disabled where the limitations imposed by the work-related disability, coupled with other factors, such as limited educational background and work history, render the claimant incapable of gainful employment" ( Matter of Barsuk v Joseph Barsuk, Inc., 24 AD3d 1118, 1118 [citations omitted], lv dismissed 6 NY3d 891, lv denied 7 NY3d 708; see Matter of Guan v CPC Home Attendant Program, Inc., 50 AD3d 1218, 1219-1220). Whether a claimant has such a total industrial disability presents a question of fact for the Board to resolve and its determination will not be disturbed if supported by substantial evidence ( see Matter of Guan v CPC Home Attendant Program, Inc., 50 AD3d at 1220; Matter of Newman v Xerox Corp., 48 AD3d 843, 843).

Here, claimant testified that he had not worked since 1992, cannot sit, stand or walk for more than 15 minutes at a time, takes pain relief and anti-anxiety medications that make him drowsy, and has to lie down 16 to 18 hours a day in order to manage his pain. According to the rehabilitation counselor who evaluated claimant on behalf of the Board, these physical limitations, when considered in connection with claimant's employment history, rendered claimant incapable of sustaining gainful employment. Although the employer's vocational rehabilitation counselor expressed a contrary view in her report, her testimony at the hearing was inconclusive as to whether claimant was employable, and the Board was entitled to reject her opinion in favor of that of the Board's vocational rehabilitation counselor ( see Matter of Utley v General Motors Corp., 285 AD2d 843, 844). Since substantial evidence supports the Board's determination that claimant was totally industrially disabled as a result of his back injury, it will not be disturbed. The employer and carrier's contentions to the contrary mainly involve conflicts in the medical evidence and questions of credibility that were for the Board to resolve ( see Matter of Newman v Xerox Corp., 48 AD3d at 844; Matter of Yanarella v IBM Corp., 195 AD2d 620, 621-622).

Next addressing the Board's action in modifying claimant's average weekly wage, we reject the employer and carrier's contention that the Board could not modify the 1993 decision establishing claimant's average weekly wage absent an appeal from that decision or an application to reopen. It is clear that the Board maintains continuing jurisdiction over workers' compensation claims and is empowered to "make such modification or change with respect to former findings, awards, decisions or orders relating thereto, as in its opinion may be just" (Workers' Compensation Law § 123; see Matter of Bey v Aramark Healthcare Support Servs., Inc., 26 AD3d 607, 607, lv denied 7 NY3d 702; Matter of Farcasin v PDG, Inc., 286 AD2d 840, 840-841).

Nor do we conclude that the Board erred in finding that modification of claimant's average weekly wage is not barred by the doctrine of laches. Laches may be applied in the context of a workers' compensation case where there is a "[f]ailure to assert a right for an `unreasonable and unexplained length of time, accompanied by other circumstances causing prejudice to an adverse party'" ( Matter of Hollo way v West St. Trucking, 14 AD3d 816, 817, quoting Matter of Taylor v Vassar Coll., 138 AD2d 70, 73; see Matter of McGuinness v John P. Picone, Inc., 36 AD3d 1032, 1032). Whether the doctrine applies is a question of fact for the Board to resolve and its decision must be upheld if supported by substantial evidence ( see Matter of Hopkins v Alcas Corp., Cutco Cutlery, 63 AD3d 1342, 1343; Matter of Manticoff v American Bldg. Maintenance, 63 AD3d 1308, 1309-1310).

Here, the 1993 decision setting claimant's average weekly wage was based upon the C-240 form submitted to the Board by the employer, which improperly set forth claimant's wages for the 39 weeks he worked for the employer, rather than the average wage of a similar worker, as was required. A claimant's average daily wage is used in determining his or her annual average wage only when such claimant has worked in the same job for substantially all of the year preceding his or her injury ( see Workers' Compensation Law § 14). Where, as here, a claimant did not work in the same job for substantially all of the year preceding his or her injury, such claimant's average annual wage is determined by applying a statutory multiplier to the average daily wage of "an employee of the same class working substantially the whole of such immediately preceding year in the same or in a similar employment in the same or a neighboring place" (Workers' Compensation Law § 14). Thus, since claimant did not work for the employer for substantially all of the whole year prior to his injury, his average weekly wage should not have been based upon his actual wages during the 39 weeks of his employment.

As will be more fully discussed below, if neither of the previous methods can "reasonably and fairly be applied," Workers' Compensation Law § 14 directs that a claimant's average annual wage be computed based on "such sum as . . . shall reasonably represent the annual earning capacity of the injured employee" (Workers' Compensation Law § 14).

The employer and carrier urge, as it did before the Board, that the employer was prejudiced by claimant's delay in seeking modification of his average weekly wage because it was unable to provide the wages of a similar worker. While there can be little dispute that claimant's nearly 15-year delay in seeking modification of his average weekly wage was excessive, it cannot be overlooked that it was the employer, in the first instance, who erroneously failed to set forth the wages of a similar worker. This was notwithstanding the clear and unequivocal directive contained in the C-240 form itself, which instructed the employer to provide the weekly gross earnings of a similar employee where the injured employee did not work for at least 234 days (based on a five-day work week) during the year preceding the injury. Clearly, the employer knew or should have known from the outset that claimant's average weekly wage was erroneously set and, in our view, the employer's inability to furnish the payroll records of a similar employee at the time of claimant's injury is due, at least in part, to its own neglect ( cf. Matter of Holloway v West St. Trucking, 14 AD3d at 817). Moreover, under the particular circumstances of this case, we fail to find any real prejudice flowing from the employer's inability to provide the wages of a similar worker. To that end, this Court has held that Workers' Compensation Law § 14 (2) was not intended to be employed "in the case of salesmen whose income is largely dependent upon commissions," reasoning that "the income of one individual from commissions offers no accurate method of determining the income of another, and does not reasonably represent the annual earning capacity of an injured employee" ( Matter of Delmonte v Sears, Roebuck Co., 12 AD2d 548, 548 [I960]). Under such circumstances, we concluded that "neither of the methods provided for in subdivision[s] 1 and 2 [of Workers' Compensation Law § 14] can fairly and reasonably be applied, and all of the factors provided for in subdivision 3 should be given consideration, including the actual earnings of claimant, in arriving at a figure which shall reasonably represent the annual earning capacity of the injured employee" ( id. at 549 [internal quotation marks and citations omitted]). For these reasons, we find that the Board's refusal to invoke the doctrine of laches to bar claimant from seeking modification of his average weekly wage is supported by substantial evidence and, as such, will not be disturbed ( see Matter of Manticoff v American Bldg. Maintenance, 63 AD3d at 1310; Matter of Holloway v West St. Trucking, 14 AD3d at 817).

As for the merits of the Board's modification, substantial evidence supports its finding that claimant's annual earning capacity is most accurately determined by averaging his earnings from the last 10 weeks of employment. Workers' Compensation Law § 14 (3) directs that, where neither of the methods set forth in subdivisions (1) and (2) can "reasonably and fairly be applied," a claimant's average weekly wage must be computed based on "such sum as . . . shall reasonably represent the annual earning capacity of the injured employee in the employment in which he [or she] was working at the time of [his or her] accident." Here, the WCLJ implicitly accepted claimant's argument that his earnings in the last 10 weeks of employment would most accurately reflect his earning capacity at the time of the accident, since he was a new employee and did not receive commissions in his first several weeks of employment. However, in so doing, the WCLJ incorrectly utilized claimant's earnings during his last 11 weeks of employment and divided that sum by 10, and thus we modify by basing claimant's average weekly wage on his last 10 weeks of employment, resulting in an average weekly wage of $592.23.

We have examined the employer and carrier's remaining contentions and find them to be lacking in merit.

Ordered that the decision is modified, without costs, by reversing so much thereof as amended claimant's average weekly wage to $624; claimant's average weekly wage is set at $592.23; and, as so modified, affirmed.

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IN RE SACCO
(Mar 18, 2010)