IN RE: the Claim of David W. HOWARD (2010)

Appeal from a decision of the Workers' Compensation Board, filed October 6, 2008, which determined that claimant violated Workers' Compensation Law § 114-a.

Claimant suffered a work-related injury in March 2003 and submitted a claim for workers' compensation benefits. After a hearing, the Workers' Compensation Law Judge (hereinafter WCLJ) established the injury, awarded benefits, and authorized surgery to be covered by the workers' compensation carrier, the State Insurance Fund (hereinafter SIF). Claimant was subsequently indicted on charges of insurance fraud in the third degree, grand larceny in the third degree, offering a false instrument for filing in the first degree, and violating Workers' Compensation Law § 114. These charges arose from evidence collected by SIF allegedly revealing that claimant was employed while collecting benefits.¹ In June 2007, claimant entered an Alford plea to the charge of insurance fraud in the fourth degree. He was convicted and sentenced in accordance with this plea agreement to a conditional discharge upon payment of restitution, and a certificate of relief from disabilities was issued.

At a subsequent hearing, SIF asked the WCLJ to find that claimant's plea and conviction disqualified him from receiving benefits pursuant to Workers' Compensation Law § 114-a. Claimant requested a hearing. After affording the parties an opportunity to brief the issue, the WCLJ determined that the criminal proceedings did not involve a full hearing on the merits and, thus, claimant was entitled to a hearing. SIF sought review. The Workers' Compensation Board found that a violation of Workers' Compensation Law § 114-a had occurred, based upon claimant's criminal conviction.² The Board modified the WCLJ's decision and returned the case for the determination of appropriate penalties. Claimant appeals.

Initially, we disagree with the SIF's claim that this appeal was improperly taken from an interlocutory decision. The question posed, i.e., whether claimant violated Workers' Compensation Law § 114-a, is a potentially dispositive threshold legal issue (see Matter of Michaels v. Towne Ford, 9 A.D.3d 733, 733 n., 780 N.Y.S.2d 234 [2004] ). “[O]ur policy to discourage piecemeal review of the main issues in a compensation claim ․ should not be applied in such a manner as to preclude, as in this case, the prompt review of threshold legal issues which may be dispositive” (Matter of McDowell v. LaVoy, 59 A.D.2d 995, 995, 399 N.Y.S.2d 709 [1977]; see Matter of Pisarek v. Utica Cutlery, 26 A.D.3d 619, 619, 809 N.Y.S.2d 623 [2006] ).

The Board relied upon the equitable doctrine of collateral estoppel in rendering its determination. This doctrine is based on the concept that it is unfair to permit a party to relitigate an issue that has previously been decided against it (see Kaufman v. Eli Lilly & Co., 65 N.Y.2d 449, 455, 492 N.Y.S.2d 584, 482 N.E.2d 63 [1985] ). There are two fundamental requirements: “ ‘[f]irst, the identical issue necessarily must have been decided in the prior action and be decisive of the present action, and second, the party to be precluded from relitigating the issue must have had a full and fair opportunity to contest the prior determination’ ” (Matter of Juan C. v. Cortines, 89 N.Y.2d 659, 667, 657 N.Y.S.2d 581, 679 N.E.2d 1061 [1997], quoting Kaufman v. Eli Lilly & Co., 65 N.Y.2d at 455, 492 N.Y.S.2d 584, 482 N.E.2d 63; accord Alaimo v. McGeorge, 69 A.D.3d 1032, 1033, 893 N.Y.S.2d 331 [2010] ). Here, SIF did not meet its burden of demonstrating the identity of issues (see Kaufman v. Lilly & Co., 65 N.Y.2d at 456, 492 N.Y.S.2d 584, 482 N.E.2d 63). To satisfy this requirement, the issue in question must have been “actually litigated and resolved in the prior proceeding” (Matter of Halyalkar v. Board of Regents of State of N.Y., 72 N.Y.2d 261, 267, 532 N.Y.S.2d 85, 527 N.E.2d 1222 [1988] ).

Here, the determinative issue was not whether claimant had been convicted of a crime (contrast Matter of Hopfl, 48 N.Y.2d 859, 860, 424 N.Y.S.2d 350, 400 N.E.2d 292 [1979]; Matter of Feuereisen v. Axelrod, 100 A.D.2d 675, 675-676, 473 N.Y.S.2d 870 [1984], lv. denied 62 N.Y.2d 605, 479 N.Y.S.2d 1025, 468 N.E.2d 57 [1984] ), but whether he “knowingly ma[de] a false statement or representation as to a material fact” (Workers' Compensation Law § 114-a) for the purpose of obtaining workers' compensation benefits or influencing a payment determination. An Alford plea, by its very nature, is accepted on the explicit basis that the person making the plea does not admit having committed the charged acts (see North Carolina v. Alford, 400 U.S. 25, 37, 91 S.Ct. 160, 27 L.Ed.2d 162 [1970]; People v. Miller, 239 A.D.2d 787, 788, 658 N.Y.S.2d 482 [1997], affd. 91 N.Y.2d 372, 670 N.Y.S.2d 978, 694 N.E.2d 61 [1998] ). When claimant entered his Alford plea, he “was not required to and did not admit his participation in the acts constituting the crime” (People v. Green, 249 A.D.2d 691, 693, 671 N.Y.S.2d 777 [1998] ). On the contrary, he made no factual admissions, his counsel specified that he was pleading guilty “without an admission of wrongdoing,” and the transcript of the plea proceeding includes no discussion of the factual basis for the charge. The question of whether claimant committed the charged conduct, though decisive in determining whether he violated Workers' Compensation Law § 114-a, was not determined in the criminal action.³ Thus, the requirement of identicality was not met, and collateral estoppel does not apply (see Matter of Halyalkar v. Board of Regents of State of N.Y., 72 N.Y.2d at 267, 532 N.Y.S.2d 85, 527 N.E.2d 1222; Kaufman v. Eli Lilly & Co., 65 N.Y.2d at 456, 492 N.Y.S.2d 584, 482 N.E.2d 63).⁴ Claimant must be provided “an ample opportunity to address the issue of whether he knowingly misrepresented material facts” sufficient to establish the charged violation (Matter of Robbins v. Mesivtha Tifereth Jerusalem, 60 A.D.3d 1166, 1167, 874 N.Y.S.2d 638 [2009].

ORDERED that the decision is reversed, without costs, and matter remitted to the Workers' Compensation Board for further proceedings not inconsistent with this Court's decision.

GARRY, J.

PETERS, J.P., SPAIN, LAHTINEN and STEIN, JJ., concur.