NEW DECISION

Jing Huo Lac v American Tr. Ins. Co., 2008 NY Slip Op 51177(U) (Civ Ct City NY, Richmond County)

Defendant moves to dismiss the action on the ground that the assignor is entitled to Workers Compensation because she was attached to a taxi corp/ car service base as an employee and that the Workers Compensation Board ("Board") has primary jurisdiction over issues of coverage. Defendant had previously denied plaintiff's claim based upon the aforementioned reason (See Explanation of Benefits and NF 10 form attached as Exhibit 6 to defendant's motion.) Defendant asserts that this court therefore lacks jurisdiction to hear the complaint pursuant to 11 NYCRR § 65-3.16(a)(9), Section 142 (7) of the Workers Compensation Law and precedent. Defendant also seeks to amend its answer to include the affirmative defense that this court lacks subject matter jurisdiction.

Plaintiff asserts that "a no-fault insurer asserting a defense that Workers Compensation is primary would need to establish, as a threshold matter, that the claimant was employed at the time of the underlying motor vehicle accident." Plaintiff asserts that defendant failed to submit any admissible evidence that the assignor was employed at the time of the accident. To this end, plaintiff contends that the police accident report, which states that the TLC license plate on the car Acosta was driving is registered, is inadmissable as rank hearsay since there is no proof that the officer saw the accident. Even assuming, arguendo, that the report is admissible, plaintiff contends that defendant still has failed to establish that the assignor was "working" at the time of the accident; i.e. that the accident occurred during the course of employment.

Plaintiff and defendant stipulated at oral argument that the main issue before the court [*2]was whether the Workers Compensation Board has primary jurisdiction over the factual question of whether plaintiff's assignor was acting within the scope of her employment at the time of the accident. An ancillary but determinative issue is whether the police accident report, which sheds light upon the issue of the assignor's employment, is admissible.

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The police accident report (exhibit 7) does not have the two boxes - "not investigated at scene" and "accident reconstructed" on the first line checked off. Therefore, the police officer who filled out this form presumably observed the results of the accident. The accident report also sets forth that the car is registered to the Katt Corporation and lists the insurance policy number. The accident report checks off that a duplicate copy must be sent to the NYC Taxi & Limousine Commission.

The only document that relates to plaintiff's employment, or lack thereof, is the NF-3 - "Verification of Treatment by Attending Physician or other provider of Health Service" (Exhibit 2 to defendant's moving papers) which was presumably filled out by plaintiff Lac. Question number 4 - Occupation - is filled out as not applicable and question number 10 - "is condition due to injury arising out of patient's employment?" is answered as "No" . The NF-3 is not signed but notes that the signature is on file

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Plaintiff contends that before a defendant insurance company can argue that the Board has primary jurisdiction, it must establish, as a threshold matter, that the claimant was employed at the time of the underlying motor vehicle accident, citing Global Liberty Ins. Co. v. Abdelhaq, 36 AD3d 909 ( 2d Dept. 2007). It also asserts that it is impossible for defendant to establish employment since the one document that might shed light on the assignor's employment - the police accident report - is rank hearsay.

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After citing the aforementioned precedent for the proposition that Worker's Compensation is primary, the Lenox court stated that the "defendant must show only that there is potential merit' to its claim that [the assignor] was employed at the time of the accident so as to trigger a determination by the Workers' Compensation Board. Id. citing A.B. Medical Serv. PLLC v. American Transit Ins. Co., 8 Misc 3d 127A, 801 NYS2d 776 [App. Term 2d Dept. 2005). The court found that the NF-2 stating that the assignor was employed at the time of the accident, and the observation of the police officer that the vehicle was a taxi, was sufficient for defendant to meet its burden. The court also noted that the plaintiff had failed to tender any evidence about the assignor's employment status.

Conversely, in A.B. Medical, supra , the court found that the insurance company had failed to establish the defense's "potential merit" so as to warrant the Workers Compensation Board's review of the facts. As against plaintiff' s proof - the assignor's sworn statement that he was not working when the accident occurred and the purported employer' s sworn statement that the assignor was not working - the insurance company interposed only a claim adjuster's statement that claimant was eligible for Workers Compensation, based upon an employer's unsworn statement dated 18 months before the accident, and a police accident report that the court would not consider since it was offered for the first time in defendant's reply papers. The court therefore concluded that the defendant's claim that the assignor acted in the course of his employment at the time of the accident was "mere speculation" and failed to establish any issues of fact regarding Worker's Compensation coverage that must be resolved by the Board.

In all cited cases but one ^[FN3] the courts have found primary jurisdiction to rest with the Board only where the movant has presented evidence about the employment relationship above and beyond a police accident report, i.e. the "right of control, method of payment, furnishing of material and nature of work, which are traditionally considered in determining whether an employment relationship existed". Arvatz v. Empire Mutual Ins. Co, supra , 171 AD2d at 267. See, Juan Lapont v. Savvas Cab Corp., 244 AD2d 208 (1st Dept. 1997) (sufficient facts presented to demonstrate potential merit of Workers Compensation defense: plaintiff's supervisor gave him work assignments and distributed his wages; supervisor also provided affidavit stating that he and plaintiff were both employees at defendant cab corporation and that defendant maintained a Workers Compensation insurance policy for its employees ); Hammer Associates, Inc v. Delmy Productions, Inc., 118 AD2d 441 (1st Dept. 1986) ( plaintiff entered into a written contract for a stipulated sum for a term certain and the time and place where he would work was determined by defendants leading to court's conclusion that plaintiff was an employee "as a [*6]matter of law" ); Weber v. State, supra (claimant's decedent employed by the State as a custodian, the policy of compensation insurance covering claimant was procured by state and was in full force and effect at time of accident, and claimant' s demise arose out of and in course of employment); Lenox Hill Radiology, supra (police accident report and application for no-fault benefits (N-F 2)..

Based on the aforementioned precedent and the evidence presented, this court concludes that the defendant has failed to show that there is potential merit' to its claim that the assignor was employed at the time of the accident so as to trigger a determination by the Workers' Compensation Board. Its motion for summary judgment to dismiss the complaint is denied. (Emhasis Mine)