Did N.Y. Workers’ Comp Claimant Provide Grounds for Reopening Overpayment Decision?

What Do You Think?

When a claimant tries to claw back what he thinks is his several years after a decision against him came down, the record -- including recordings -- may come back to haunt him, as happened in a recent Empire State case.

A New York claimant filed a claim for workers' compensation benefits as a result of the COVID-19 pandemic. The Department of Labor issued initial determinations finding claimant ineligible to receive unemployment insurance benefits and federal pandemic unemployment compensation on the ground that he was not totally unemployed due to his continued employment with his employer.

The Department also charged the claimant with a recoverable overpayment of unemployment insurance benefits and FPUC, and, in light of its finding that claimant made willful misrepresentations in order to receive benefits and imposed a monetary penalty and a forfeiture of future benefit days.

At a hearing, the claimant admitted receiving the subject benefits while working three or more days per week during the relevant time period due to his financial circumstances at that time. Upon the Administrative Law Judge seeking clarification, the claimant denied making a false statement and expressed his desire to excuse himself from the hearing.

The ALJ then stated a withdrawal decision would be issued and explained the consequences to claimant, namely that the Department's initial determinations would remain in effect because the claimant elected not to proceed at the hearing. The ALJ granted the claimant's application to withdraw his hearing request and continued in effect the initial determinations.

Several years later, the claimant applied to reopen the withdrawal decision, and during a hearing, the claimant was afforded an opportunity to listen to the recording of his prior hearing and provide testimony in support of his application to reopen.

The ALJ subsequently denied the claimant's application to reopen, finding that the claimant failed to provide a compelling reason or a reasonable excuse for waiting more than three years to seek reopening of the withdrawal decision.

The Unemployment Insurance Appeal Board affirmed the ALJ's decision, and the claimant appealed to the Appellate Division.

In New York, a case may be reopened following withdrawal of a hearing request if good cause for the withdrawal was demonstrated.

Was there "good cause" to reopen the ALJ's withdrawal decision?

A. Yes. The claimant was confused or overwhelmed at the initial hearing.

B. No. The ALJ explained to the claimant his rights, read the initial determinations to him, and confirmed that the claimant understood the issues and procedures.

If you answered B, you agreed with the Appellate Division's findings in Matter of Torres, No. CV-26-0352 (N.Y. App. Div. 07/23/26), which affirmed the Board's upholding the ALJ's decision.

According to the court, "Despite stating that he was ready to proceed, claimant soon thereafter expressed his desire to excuse himself from the hearing notwithstanding the ALJ explaining to him the consequences of that decision including that the Department's initial determinations would remain in effect."

Based on this evidence in the record, the court found that the claimant's story didn't hold up.

"Claimant's contention that he was confused and/or overwhelmed is not only belied by the record but simply presented a credibility determination for the Board to resolve," the court wrote. 

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