For employees, there is a safety net in place to help them following a workplace accident. Part of this safety net is workers’ compensation. Workers’ compensation helps to pay for expenses arising out of an injury that occurred at work. These expenses can include medical bills, rehabilitative costs and lost wages. If an injury is permanent and a worker is unable to work, workers’ compensation can help give that employee much needed income.

In New York, there is also the Special Disability Fund which reimburses some employers for workers’ compensation costs when an employee’s pre-existing condition causes or exacerbates the injury. One Schenectady business was recently denied coverage under the Special Disability Fund.

In this case, a woman had worked for the business for almost 20 years. In May 2002, the woman was helping students get off a bus when she was injured. During the accident, she injured her back and shoulder and was left disabled. The Workers’ Compensation Board ruled that the Special Disability Fund should reimburse the business because of the woman’s pre-existing diabetes and obesity. The Fund appealed.

The appellate court ruled that since the employee’s diabetes and weight did not affect her job performance before the accident, they cannot be considered pre-existing conditions. Since the woman testified that her diabetes was well controlled and that since no medical condition caused her to be heavier, the business did not qualify for reimbursement.

In this situation, the woman still receives her benefits the employer just will not be reimbursed for its expenses relating to those benefits. For workers and employers alike, the workers’ compensation system can be complex to navigate. Rulings can be made at the Workers’ Compensation Board and in the courts that can affect certain cases. However, with the right help, people can get the benefits they need and deserve.

Source: Workforce, “Pre-existing Perspective: New York Court Rules Against Reimbursing Employer,” Max Mihelich, Feb. 11, 2013