N.Y. Presumption Leads Court to Find Fall Happened in Course of Employment

If a worker falls on the job, but no one saw what happened, what happens?

The court in Bosque v. Prime Support Inc., 2024 WL 1774127 (N.Y. App. Div. 04/25/24) addressed the question, applying a presumption to find that the fall happened in the course of employment.

A home health care aide fell in a hallway after cleaning a patient's bedroom. The patient's mother found the aide face on the floor, bleeding and unresponsive. The aide was diagnosed with a subarachnoid hemorrhage, central cord syndrome, and mild traumatic brain injury.

The aide underwent surgery and filed a claim for workers' compensation benefits. The Workers' Compensation Law Judge found that the aide sustained a work-related injury to her head, neck, and right arm and awarded benefits. The carrier sought administrative review, claiming that the injuries were not due to a risk incident to her employment. The Workers' Compensation Board disagreed, finding that the aide sustained compensable work-related injuries.

The carrier appealed to court.

New York law provides a presumption of compensability for accidents that occur during the course of employment that are unwitnessed or unexplained. Carriers may rebut this presumption with "substantial evidence to the contrary."

Workers' Comp 101: In Quigley v. Concern for Independent Living, 146 A.D. 3d 1185 (N.Y. App. Div. 2017), a worker fell while walking down a hallway at work. The employer claimed that the fall was due to an "idiopathic condition" because the worker used a cane. The court disagreed, explaining that the worker used a cane due to an arthritic condition in her knee, but she wasn't having problems with her knee at the time of the fall. "There are no medical opinions in the record connecting claimant's fall to any idiopathic reasons," the court wrote.

In this case, the carrier didn't have such evidence.

"Although the carrier argues that the cause of claimant's fall was idiopathic in nature, this assertion is entirely speculative, as the carrier produced no medical evidence 'to explain the etiology' of claimant's fall and apparent loss of consciousness," the court explained.

As a result, the court upheld the board's decision in the aide's favor.

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