Missing 20-Day Deadline for Hearing didn’t Require Benefit Reduction

Case File

Did not meeting a 20-day deadline require a reduction in benefits? Simply Research subscribers have access to the full text of the decision.

Case

Juncal v. Maspeth Remodeling, No. CV-23-2242 (N.Y. App. Div. 05/29/25)

What Happened

The claimant established a claim for physical injuries suffered as a result of a fall at work, and he was awarded benefits at a temporary total disability rate.

Following an independent medical examination by an orthopedic consultant for the carrier, the carrier filed a Request for Further Action, seeking a reduction of the claimant's weekly benefits to half of his TTD rate previously awarded.

While that request was pending, the claimant was evaluated by a psychiatrist who diagnosed him with causally related moderate-to-sever psychiatric injuries.

At a hearing, the claimant requested a finding regarding his consequential psychiatric injuries, and the Workers' Compensation Law Judge found prima facie medical evidence for the consequential injuries and that the claimant was entitled to ongoing benefits at the TTD rate.

The carrier appealed, and the Workers' Compensation Board affirmed, denying the employer's request to retroactively reduce the claimant's temporary disability benefit rate.

The carrier appealed to Appellate Division, arguing that the hearing on its reduction request was not held within 20 days pursuant to 12 NYCRR 300.23(b)(2).

Rule of Law

Under 12 NYCRR 300.23(b), where the Board has made an award of compensation at a temporary total or partial disability rate and directed the continuation of payments at that rate, the carrier may not suspend or reduce the payments until: 1) it has filed a notice of intention to suspend or reduce benefits with the chair in the district office where the case is assigned, with supporting evidence; and 2) the chair has scheduled a hearing on the issue within 20 days and there is a finding that such suspension or reduction is justified

What Appellate Division Said

Appellate Division affirmed the Board's ruling, explaining that the regulation does "not provide or suggest that, in the absence of a hearing scheduled by the Board addressing the degree of disability, benefits must be reduced or suspended merely upon the passage of 20 days."

Instead, the regulation provides that where there are no regularly scheduled hearings within 20 days, the Board "may" schedule a hearing "at another available hearing point."

Although previous Board decisions have interpreted the 20-day requirement to permit a reduction in a claimant's benefit, Appellate Division clarified that the timeframe was "directory or aspirational rather than mandatory."

Verdict: Affirmed. Appellate Division held that the Board's decision to award the claimant ongoing benefits up until the hearing was not an abuse of discretion.

Takeaway

When a claimant is receiving continuing benefits at a temporary rate, 12 NYCRR 300.23(b)(2) does not mandate that a hearing be held within 20 days or that a claimant's benefits be reduced or suspended after 20 days from the filing of a request to reduce or suspend benefits where a hearing has not been held within that time period.

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