| Matter of Davidson v LaGrange Fire Dist. |
| 2011 NY Slip Op 02666 [82 AD3d 1227] |
| March 29, 2011 |
| Appellate Division, Second Department |
| In the Matter of Deborah A. Davidson,Appellant, v LaGrange Fire District et al., Respondents. |
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In a proceeding pursuant to CPLR article 78, inter alia, in the nature of mandamus, in effect,to compel a final determination by the respondents of the petitioner's application for medicalbenefits under General Municipal Law § 207-a, the petitioner appeals from a judgment ofthe Supreme Court, Dutchess County (Sproat, J.), dated September 30, 2009, which denied thepetition and dismissed the proceeding, without prejudice, on the ground that the petitioner failedto exhaust her administrative remedies before the New York State Workers' CompensationBoard.
Ordered that the judgment is reversed, on the law, with costs, the petition is reinstated, andthe matter is remitted to the Supreme Court, Dutchess County, for further proceedings on thepetition consistent herewith.
After sustaining an injury on a fire call, the petitioner was removed from active duty as afirefighter by the LaGrange Fire District (hereinafter the Fire District), and was awarded salarybenefits pursuant to General Municipal Law § 207-a. The petitioner also requested medicalbenefits to cover her for lymphatic drainage massage therapy and physical strength trainingtherapy, which had been denied by the New York State Insurance Fund (hereinafter NYSIF),which was the workers' compensation insurance carrier for the Fire District and the LaGrangeBoard of Fire Commissioners (hereinafter the Board). The petitioner wrote a letter to the Board,requesting coverage pursuant to General Municipal Law § 207-a for the lymphaticdrainage massage therapy and the physical strength training therapy. The petitioner repeated thisrequest approximately 13 months later in a second letter to the Board. According to thepetitioner, she received no response from the Board.
The petitioner's attorney subsequently sent a letter to an attorney representing the FireDistrict and the Board (hereinafter together the respondents), requesting that the Fire Districtprovide coverage pursuant to General Municipal Law § 207-a for the full cost of kneesurgery. In response, the respondents' attorney advised the petitioner's attorney that the requestfor medical coverage should be submitted to the New York State Workers' Compensation Board(hereinafter the WCB). The petitioner's surgery was estimated to cost $5,484, and NYSIFinformed the petitioner that it would cover only $4,657.32 for this type of procedure. Thepetitioner apparently submitted a request for coverage to the WCB, and an administrative lawjudge for the WCB determined that NYSIF was liable for the full cost of the petitioner's surgery.NYSIF filed an application for full board review [*2]with theWCB.
Before a decision was rendered by the WCB Office of Appeals, the petitioner commencedthis CPLR article 78 proceeding against the respondents. The petition, among other things,sought mandamus, in effect, to compel the respondents to issue a final determination as to thepetitioner's request for medical benefits under General Municipal Law § 207-a.
The Supreme Court denied the petition and dismissed the proceeding, without prejudice tothe petitioner seeking further judicial review after exhaustion of her administrative remedies. TheSupreme Court concluded that the petitioner had not exhausted her administrative remedies,since no final determination of the petitioner's claim had been made by the WCB. We reverse.
Where an officer or agency failed or refused to conduct a hearing or decide a particularmatter where there was a mandatory, nondiscretionary duty to do so, mandamus is appropriate tocompel performance of the required duty (see Klostermann v Cuomo, 61 NY2d 525, 540[1984]; Matter of Utica Cheese v Barber, 49 NY2d 1028 [1980]; Matter of 2433Knapp St. Rest. Bar v Department of Consumer Affairs of City of N.Y., 150 AD2d 464[1989]). Pursuant to General Municipal Law § 207-a, a firefighter "who is injured in theperformance of his duties . . . so as to necessitate medical . . .treatment, shall be paid . . . the full amount of his regular salary or wages until hisdisability arising therefrom has ceased, and, in addition, [the] fire district shall be liable for allmedical treatment and hospital care furnished during such disability" (General Municipal Law§ 207-a [1]). Here, the petitioner contends that, although the respondents have made adetermination that she is entitled to receive benefits under General Municipal Law § 207-a,as evidenced by the fact that they have paid her regular salary since her removal from active duty(see Matter of Crawford v Sheriff's Dept., Putnam County, 152 AD2d 382, 386 [1989]),the respondents, despite multiple requests on her part, have not made a determination regardingcoverage under General Municipal Law § 207-a for her knee surgery, lymphatic drainagemassage therapy, and physical strength training therapy.
A determination by the WCB regarding workers' compensation benefits, and a determinationby a municipal employer regarding statutory benefits pursuant to General Municipal Law §207-a, are separate and distinct matters. The Court of Appeals made this clear in Matter ofBalcerak v County of Nassau (94 NY2d 253 [1999]), where it held that a determination bythe WCB that an injury is work-related does not, by operation of collateral estoppel,automatically entitle an injured employee to benefits under General Municipal Law §207-c (the counterpart to General Municipal Law § 207-a that applies to police officers). Amunicipality's obligation to pay wages and medical costs under General Municipal Law§§ 207-a or 207-c is in no way dependent upon any determination made by theWCB. Rather, "the eligibility determinations for these distinct types of statutory benefits" must"stand and be resolved essentially on their own merits" (Matter of Balcerak v County ofNassau, 94 NY2d at 261).
Here, any workers' compensation remedies that may have been available to the petitionerwere separate from and independent of her request that the respondents provide coverage for thefull cost of her knee surgery under General Municipal Law § 207-a. Thus, contrary to theSupreme Court's determination, the petitioner was not required to exhaust her administrativeremedies in the workers' compensation proceeding before pursuing this CPLR article 78proceeding against the respondents. We further note that the Supreme Court failed to addressthose branches of the petition which sought coverage for lymphatic drainage massage therapyand physical strength training therapy.
Accordingly, the petition should not have been denied for failure to exhaust administrativeremedies, and we remit the matter to the Supreme Court, Dutchess County, for furtherproceedings on the petition, and a new determination thereafter. Prudenti, P.J., Florio, Angiolilloand Sgroi, JJ., concur.