Brisson v. County of Onondaga

844 N.E.2d 766, 6 N.Y.3d 273, 811 N.Y.S.2d 312
CourtNew York Court of Appeals
DecidedFebruary 16, 2006
StatusPublished
Cited by22 cases

This text of 844 N.E.2d 766 (Brisson v. County of Onondaga) is published on Counsel Stack Legal Research, covering New York Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Brisson v. County of Onondaga, 844 N.E.2d 766, 6 N.Y.3d 273, 811 N.Y.S.2d 312 (N.Y. 2006).

Opinions

OPINION OF THE COURT

Read, J.

We hold that a self-insured employer or workers’ compensation carrier must preserve its right to any offset expressly and unambiguously when consenting to settlement of a third-party action, regardless of whether there is an existing lien against the claimant’s recovery. We further conclude that substantial evidence supports the Workers’ Compensation Board’s finding that the self-insured employer in this case did not do so.

I.

On November 4, 1998, claimant Alan J. Brisson, who worked in Onondaga County’s Department of Transportation, was injured when struck from behind by a van while he was picking up a “Men Working” sign from the shoulder of a road. Claimant sought workers’ compensation benefits and, in July 2000, a Workers’ Compensation Law Judge (WCLJ) issued a decision concluding that he had suffered a compensable injury to his lower back, and made awards for his periods of disability.

Claimant also filed a third-party action against the driver and owner of the van. When asked by claimant’s attorney to consent to settlement of this third-party action for $50,000, RMSCO, Inc., the third-party administrator for claimant’s self-insured employer, Onondaga County, responded on August 17, 2001 as follows: “On behalf of [the County], consent is given to the third party settlement of $50,000.00. We are assuming that this is the policy limit. We need to know the net third party proceeds.” Claimant’s attorney on August 20, 2001 wrote RM-SCO that

“I am in receipt of your letter granting this firm consent to settle [claimant’s] third party claim. It is our understanding that, based on the dollar amount of [claimant’s] third party settlement, you have no lien as well as no right to a [payment] holiday. If [276]*276you have a different understanding, please contact this office within five business days or we will proceed with this third party settlement based on our understanding.”

In an undated letter, RMSCO replied that

“[t]his letter is in response to yours of 08/20/2001.
“You indicate that you believed we have no right to a [payment] holiday. This is not entirely correct. Once lost wages and medical exceed basic economic loss, then we can take credit against net third party proceeds. For example, once lost wages are paid on or after 11/04/2001, we can take credit against net third party proceeds.”

The third-party action was, in fact, settled for $50,000 on September 24, 2001. After payment of taxable costs, disbursements and attorneys’ fees, claimant netted $32,958.73.

On October 5, 2001, RMSCO sent claimant a “Notice that Payment of Compensation has been Stopped or Modified.” The notice stated that claimant’s benefits would cease on the three-year anniversary of the accident, November 4, 2001, and would not resume for 168.2 weeks, or until January 24, 2005, so as to offset net settlement proceeds.

Claimant protested the suspension of his benefit payments at a hearing before a WCLJ on January 24, 2002. Another WCLJ concluded in a decision issued on July 10, 2002 that the County was, in fact, not entitled to offset claimant’s future workers’ compensation payments. While the County had indisputably consented to the settlement, “[t]here was no specific reservation [of the County’s] right to claim credit [for the settlement].” The WCLJ relied upon Matter of Hilton v Truss Sys. (82 AD2d 711 [3d Dept 1981], affd for reasons stated below 56 NY2d 877 [1982]) for the proposition that “an employer must unambiguously preserve its offset rights against future benefits, or such rights will be deemed waived.”

On August 9, 2002, the County asked the Board to review the WCLJ’s decision, disputing the WCLJ’s reading of Hilton and arguing that “[b]ecause, in consenting to the settlement . . . , the self-insured employer neither waived nor compromised a workers’ compensation lien, there was no requirement that the self-insured employer expressly reserve its offset rights.” Alternatively, the County contended that the correspondence between RMSCO and claimant’s attorney, in fact, reserved its offset rights.

[277]*277In its decision issued on November 18, 2002, the Board rejected the County’s arguments, and agreed with the WCLJ that a self-insured employer must “unambiguously preserve its offset rights” when consenting to settlement “or such rights will be deemed waived.” The Board further concurred with the WCLJ that

“the self-insured employer failed to unambiguously reserve its rights to an off set [sic] against future awards when it consented to the third party settlement. To preserve its rights in this case, the self insured employer’s first correspondence on this issue should have contained a clear statement of its reservation of this right or the second correspondence should have withdrawn the consent, issued in the first, pending the resolution of the issue raised in the claimant’s attorney’s correspondence.”

Accordingly, the County was “not entitled to any offset of workers’ compensation benefits against the third party settlement paid to the claimant.”

Upon the County’s appeal, the Appellate Division affirmed, turning down the County’s argument that Hilton mandates only that carriers with existing hens must preserve the right to offset future benefit payments plainly and unambiguously. The Appellate Division also observed that “whether the employer adequately preserved its right to a future offset in a particular case is a factual issue for the Board, and [its] decision will be upheld if supported by substantial evidence,” which the Court found in this case (12 AD3d 976, 977-978 [3d Dept 2004]). We granted the County permission to appeal, and now affirm.

II.

Under Workers’ Compensation Law § 29 (1), a claimant may pursue a legal action against a third party for damages arising out of the accident underlying the workers’ compensation claim, but the self-insured employer or carrier has a lien on any recovery to the extent of compensation and medical expenses already disbursed. Workers’ Compensation Law § 29 (4) gives the employer or carrier a corollary right to offset a claimant’s future compensation benefits with the proceeds of any recovery. Subdivision (1-a) of section 29, however, precludes a hen under Workers’ Compensation Law § 29 (1) for benefits paid in lieu of first-party benefits which another insurer would have otherwise been obligated to pay under New York’s No-Fault Law, and cor[278]*278respondingly limits the credit or offset provision in Workers’ Compensation Law § 29 (4) (see Matter of Fellner v Country Wide Ins., 95 AD2d 106 [3d Dept 1983]). The term “[flirst party benefits” refers to “basic economic loss,” or up to $50,000 per person consisting of certain medical and other reasonable and necessary expenses as well as lost earnings for three years from the date of the accident (Insurance Law § 5102 [a], [b]; see Matter of Johnson v Buffalo & Erie County Private Indus. Council, 84 NY2d 13 [1994]). Finally, a claimant who compromises a third-party action for an amount less than the compensation benefits paid or payable under the Workers’ Compensation Law must first obtain the written consent of the entity liable to pay the benefits, or an order on notice from the court within three months of its approval of the settlement (Workers’ Compensation Law § 29 [5]).

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Brisson v. County of Onondaga
844 N.E.2d 766 (New York Court of Appeals, 2006)

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Bluebook (online)
844 N.E.2d 766, 6 N.Y.3d 273, 811 N.Y.S.2d 312, Counsel Stack Legal Research, https://law.counselstack.com/opinion/brisson-v-county-of-onondaga-ny-2006.