- Court
- New York Supreme Court, Appellate Division, Third Department
- Case
- Matter of Clement v. Colwell Brothers
- Date
- May 28, 2026
- Slip Op. No.
- 2026 NY Slip Op 03341
Background
Claimant George Clement established a workers’ compensation claim in 1989 for an occupational disease of binaural hearing loss, for which he received a twenty-three percent schedule loss of use award. In 2022, liability for the claim was transferred to Special Funds pursuant to Workers’ Compensation Law section 25-a for medical treatment and care. In 2023, audiologist Sarah Sugden filed a prior authorization request seeking approval for diagnostic testing, including tympanometry and comprehensive audiometry threshold evaluation and speech recognition. The test results from evaluations in March 2021 and March 2022 indicated severe hearing loss for conversational speech in both ears and moderate sloping to profound bilateral sensorineural hearing loss, with a recommendation for re-evaluation within a year. Special Funds denied the request at both Level 1 and Level 2 reviews. After a Level 3 adjudication hearing, a Workers’ Compensation Law Judge authorized the testing. The Workers’ Compensation Board affirmed, and the employer and carrier appealed.
Holding
The Appellate Division affirmed the Board’s decision authorizing the diagnostic hearing tests. The Court held that the evidence in the record established that the requested diagnostic testing was causally related to claimant’s established occupational hearing loss and was medically necessary. The audiologist’s recommendation for periodic re-evaluation was consistent with the medical evidence showing ongoing and potentially progressive hearing loss. The Court found that Special Funds’ denial of the prior authorization request was not supported by substantial evidence, as the medical records clearly demonstrated the need for updated diagnostic testing to assess the current state of claimant’s established hearing loss condition.
Takeaways
When a claimant has an established workers’ compensation claim for occupational hearing loss, requests for periodic diagnostic hearing evaluations are presumptively related to the established condition and require authorization unless the carrier can demonstrate that the testing is not medically necessary. Audiological recommendations for annual or periodic re-evaluations of progressive hearing conditions are medically sound practice that the Board and courts will enforce. Special Funds assuming liability under section 25-a are responsible for ongoing medical care, including routine diagnostic monitoring of the established condition.
Why It Matters
This case is important for workers’ compensation practitioners because it establishes that carriers and Special Funds cannot deny prior authorization for routine diagnostic testing related to an established occupational disease without substantial evidence that the testing is unnecessary. Claimants with established hearing loss claims are entitled to ongoing monitoring of their condition, and a recommendation from a treating audiologist for periodic re-evaluation will generally be upheld by the Board and courts. The decision reinforces the principle that workers’ compensation coverage for occupational diseases extends to the ongoing medical management of the condition, not just the initial diagnosis and treatment.