Key Takeaway
New York court clarifies that only a triable issue of fact regarding employment status is needed to refer workers compensation cases to the Workers Compensation Board.
New York’s workers compensation system operates on the principle of exclusivity — when an injury occurs during the course of employment, workers compensation benefits typically become the sole remedy available to injured workers. This means that traditional personal injury lawsuits are generally barred in favor of the streamlined workers compensation process. However, determining whether an injury actually falls under workers compensation coverage can be complex, particularly when employment status or the circumstances of an accident are disputed.
The threshold for referring these disputed cases to the Workers Compensation Board has been a subject of ongoing litigation. Courts must balance the need for thorough investigation with the practical realities of case management. Workers compensation defense requires substantiation in many instances, but the question remains: how much evidence is needed to trigger the board’s jurisdiction?
This procedural question becomes particularly important in no-fault insurance cases, where insurance companies often raise workers compensation as a defense to avoid paying benefits. Understanding when cases must be referred to the Workers Compensation Board helps clarify the boundaries between different insurance systems.
Jason Tenenbaum’s Analysis:
Great Health Care Chiropractic, P.C. v Lancer Ins. Co., 2014 NY Slip Op 50340(U)
All that is required is: ” triable issue as to whether plaintiff’s assignor had been acting in the course of his employment at the time of the accident and that, therefore, workers’ compensation benefits might be available.”
A triable issue of fact is all that is needed to kick a WC case to the board.
Also, note that the opinion again places this Court more in line with the Appellate Division which has usually held that a certificate of conformity is well plainly not needed.
Key Takeaway
This decision establishes a relatively low threshold for workers compensation referrals — courts need only find that there’s a genuine factual dispute about whether someone was working when injured. The ruling also reinforces that formal certificates of conformity aren’t required, streamlining the referral process and aligning trial courts with appellate precedent. This impacts both workers compensation coverage disputes and cases where police reports trigger workers compensation inquiries.
Legal Update (February 2026): Since this 2014 post, the Workers Compensation Board has implemented several procedural reforms and regulation amendments that may affect the threshold standards and referral processes discussed. Practitioners should verify current Workers Compensation Law provisions, board regulations, and recent appellate decisions regarding jurisdictional determinations and the interplay between workers compensation and no-fault insurance coverage disputes.
