Despite the common refrain of “coverage cannot be waived” often repeated in New York Workers’ Compensation claims involving matters where coverage issues are later unearthed, recent caselaw suggests that in certain situations, insurance carriers can end up liable for claims that would otherwise would not have been theirs.
In Northrop v. Amphenol Corp, the claimant first started treating for carpal tunnel-type complaints in 2007 before she was formally diagnosed with that condition in 2008. Claimant continued to work until she filed a claim for the condition in 2020. The claim was accepted by a carrier with an accepted date of injury in 2007 and that carrier approved a carpal tunnel release procedure. At the first hearing in 2021, however, the Workers’ Compensation Law Judge formally set the date of disablement in 2020. That finding was appealed, but the carrier was not successful in changing date of disablement back to 2007. That carrier then requested to bring in Vaughan McLean’s client as the proper carrier for the year 2020.
On behalf of our client, Vaughan McLean opposed liability for the claim. Notwithstanding that it was in fact the proper carrier for the employer on the date of disablement, we argued that by accepting the claim, authorizing surgery, and not timely raising the issue of coverage, the other carrier should be deemed liable for the claim under the doctrine of laches.
On appeal from the Workers’ Compensation Board which found the initial carrier liable despite lack of coverage for that year, the New York State Supreme Court, Appellate Division, Third Department agreed with the Board that Sentry was not liable for the claim. The Court agreed with our position that the other carrier’s delay in contesting coverage and acceptance the claim prejudiced our client’s ability to raise any defenses to the claim.
While the fact pattern may be uncommon, in situations where occupational disease claims have multiple possible dates of disablement which may be outside your coverage period, it is strongly recommended to consult with your counsel to discuss acceptance or rejection of a claim – relying on “coverage cannot be waived” is sometimes no match for “you broke it, you bought it.”
