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The Delicate Balance Between Workers’ Compensation and General Municipal Law § 207 Claims

General Municipal Law (GML) § 207 is a statutory benefit provided by municipalities to employees such as police officers, sheriffs, corrections officers, and firefighters injured in the line of duty.  Police officers, sheriffs, and corrections officers receive benefits under GML § 207-c, whereas firefighters receive benefits under GML § 207-a.  GML § 207-a and GML-207-c benefits, for workers’ compensation purposes, are essentially identical.  GML § 207 provides two benefits to an injured municipal employee who is injured or falls ill, as a result of the performance of his or her duties.  

The first benefit a municipal employee receives is medical treatment.  This benefit is indirectly covered by the workers’ compensation carrier/third-party administrator for the municipal employer, as Workers’ Compensation Law § 30 provides that benefits received under GML § 207 are credited against any such award in workers’ compensation.  

The second benefit provided by GML § 207 is the employee’s full salary while he or she is unable to work for the municipality.  While the GML § 207 benefit is statutory in nature, the mechanism for awarding this benefits is left to the individual municipality.  As a result, many departments develop their own procedure for implementing this benefit, relying on an amalgamation of statutory benefits, collective bargaining agreements, department “Past Practices,” and department “Rules and Regulations.”

So what does that have to do with workers’ compensation?  Well, workers’ compensation benefits are also a statutory requirement for employers.  The requirements for filing for GML § 207 and workers’ compensation benefits overlap in part, and drastically differ in part.  As explained by the New York Court of Appeals in Matter of Diegelman v. City of Buffalo, “workers’ compensation benefits are intended to be dispensed regardless of fault, for any injury arising out of and in the course of one’s employment, while section 207-c benefits are more expansive, but apply to a narrower class of work-related injury, relative to the performance of law enforcement duties.”  In order to prove entitlement to GML § 207 benefits, the municipal employee must prove a direct causal relationship between the performance of his or her job duties and the resulting injury or illness; it is not sufficient that the injury or illness merely occurred while at work.  Thus, the standard for activity covered under the Workers’ Compensation Law is more lenient and inclusive than that covered under GML § 207.

As entitlement to workers’ compensation and GML § 207 benefits is determined in different venues, in proceedings involving distinct burdens and procedures, a ruling regarding an employee’s entitlement to one benefit is not binding with regard to his or her entitlement to the other.  GML § 207 benefits can be denied and workers’ compensation benefits granted for the same injury.  The inverse is possible as well, though the municipal employers with both benefits do not see this scenario often.  

The litigation processes for benefits under GML § 207 and the Workers’ Compensation Law differ drastically.  Entitlement to workers’ compensation benefits is determined by the Workers’ Compensation Board – initially by a Workers’ Compensation Law Judge at a hearing.  A party may appeal the Judge’s decision to a panel of three board members, then to the full board and/or New York State Supreme Court, Appellate Division, Third Judicial Department, and finally to the New York State Court of Appeals.  GML § 207 claims generally involve an application process and then a municipality-dependent hearing process.  Once the administrative remedies for GML § 207 benefits are exhausted, a party wishing to challenge the determination would need to commence an Article 78 proceeding in New York State Supreme Court.  The majority of these appeals are transferred to the Appellate Division of the appropriate Judicial Department for review, after which a party can request further review by the Court of Appeals.

The commencement of the process for seeking benefits under GML § 207 and the Workers’ Compensation Law entails completing the proper paperwork requesting the benefit.  This is usually a fast process for GML § 207 claims, and frequently, if the claim is accepted, is completed long before there is an initial hearing in the workers’ compensation claim.  The first step in every workers’ compensation claim with an overlapping GML § 207 claim should be to identify the precise GML § 207 benefit being offered to the claimant.  If an injury or illness is covered under GML § 207, a denial under workers’ compensation still leaves the municipal employer liable for medical treatment for the injury or illness in a different venue.  

Often, in cases in which GML § 207 benefits have already been granted by the time the workers’ compensation claim is addressed, the municipality has already issued full payment for lost time to the injured employee.  In order to properly credit the municipality for prior payments, it is essential that reimbursement requests be regularly completed by the employer and filed with the Workers’ Compensation Board, to avoid a duplication of benefits and ensure that the municipality recovers up to the full amount of its prepayment of compensation to the employee.

In cases in which both GML § 207 and workers’ compensation benefits are being denied, the workers’ compensation claim is generally addressed in a quicker fashion than the GML § 207 litigation process.  As noted above, the procedures and burdens differ insofar as what is necessary to prove entitlement to each benefit.  In the workers’ compensation claim, the injured employee must still meet the standard requirements for establishing Accident/Occupation Disease, Notice, and Causal Relationship.  In the GML § 207 claim, however, besides demonstrating the above, the injured employee must prove that the injury or illness is related to his or her specific job duties.  

That last requirement leaves open a gray area when an employee is injured on the job, but not in the specific performance of his or her job duties.  In that instance, the injured employee might meet his or her burden to prove entitlement to workers’ compensation but not GML § 207, leaving the employer and carrier in the “in-between.”  The Court of Appeals has noted for decades that a fundamental principle of the Workers’ Compensation Law is to protect the worker, and that the law should therefore be liberally construed in favor of the employee.

So what does that mean for municipalities with employees stuck in the gray area?  Workers’ compensation defense alone is not enough to limit exposure.  Defenses such as attachment or voluntary removal from the labor market can be hamstrung by collective bargaining agreements if raised at inopportune times during a case.  An all-encompassing approach entailing defense of a GML § 207 claim in an effort to move the employee towards either a return to work or retirement, coupled with workers’ compensation defenses raised at the proper times, is required to limit exposure while providing municipal employees with the benefits that they are entitled to.