A nail through a work boot. A splinter of metal in a dirty work area. A piece of debris on a floor nobody cleaned.

For most workers that is a tetanus shot and a bad week. For a worker with diabetes it can be two weeks in a hospital, emergency surgery, an infectious disease consult, a vascular evaluation, and in the worst cases the loss of part of a foot or leg.

These are compensable claims. They are also among the hardest-fought claims in the system, and they are lost for reasons that have nothing to do with whether the injury happened.

The carrier’s argument is always the same

It was the diabetes, not the job.

The worker had diabetes before the shift started. He had neuropathy, maybe vascular disease, maybe a history of ulcers. The infection that put him in the hospital is a well-known complication of a disease he already had. On that account the puncture is a coincidence, and the employer owes nothing.

It is a serious argument. It is also, in a great many of these cases, wrong — and what defeats it is medical detail, not indignation.

“He never said he stepped on anything”

This is the fact that sinks these claims, and it is the one most worth understanding.

The hospital record from the first night often says the patient denied trauma. No mention of stepping on anything. Sometimes it says so explicitly. The carrier builds its whole case on that line, and to a reader who does not know the medicine it looks damning.

But diabetic neuropathy destroys protective sensation in the foot. A worker with advanced neuropathy may feel nothing at all when something goes through the sole of his boot. Not a reduced sensation — nothing. He notices something is wrong hours later, when he is feverish, or the next morning, when the foot has changed color.

So “he denied trauma” is not evidence that no trauma occurred. In a neuropathic foot it is close to what you would expect. The absence of a felt injury is a feature of the disease, and an examining physician who understands that will say so.

What the law actually requires

A claimant bears the burden of establishing causal relationship between the employment and the disability through competent medical evidence (Matter of Williams v Colgate Univ., 54 AD3d 1121 [2008]).

That opinion does not have to be expressed with absolute certainty (Matter of Norton v North Syracuse Cent. School Dist., 59 AD3d 890 [2009]). But it has to be a medical opinion supported by a rational basis indicating sufficient probability as to cause. Mere surmise, or general expressions of possibility, are not enough (Matter of Mayette v Village of Massena Fire Dept., 49 AD3d 920 [2008]) — and even an opinion that a connection is “highly possible” falls short of the reasonable probability required (Matter of Johnson v Borg Warner, Inc., 186 AD3d 1772 [2020]).

Which is why a treating doctor who says the infection “could be” related to a puncture has not helped. The opinion has to explain why, on this foot, on this timeline.

The timeline is the evidence

In a diabetic foot, infection moves fast — which cuts in the injured worker’s favor more often than carriers would like.

A worker who is fine at the start of a shift, feverish and grey within a few hours, and in an emergency room by the next morning has a sequence that is consistent with an infection seeded at work and inconsistent with a wound that had been festering for a week. The contemporaneous records from those first two or three days — the emergency room note, the podiatry consult, the infectious disease workup, the surgical findings — frequently do more work than anything anyone says at a hearing a year later.

Which is also why the condition of the work area matters. An unkempt, debris-strewn floor that someone was told to clean up is not background detail. It is part of the causal story.

The carrier’s own examiner can decide it

Injured workers assume the independent medical examination is simply the other side’s weapon. Usually it is adverse. Not always.

A consultant who examines the file honestly may end up conceding causal relationship — because the mechanism is real, the timeline fits, and a competent physician looking at an at-risk neuropathic foot and a documented puncture can see what happened. When the carrier’s own examiner concedes the connection, that concession is powerful evidence, and it is the carrier’s to live with.

So attend the IME. Describe the work area, the shift, and the sequence exactly as it happened, including that you did not feel the puncture if that is the truth.

A pre-existing condition does not disqualify you

Workers’ compensation does not require you to have been healthy. Diabetes, neuropathy, vascular disease and prior surgeries are part of who the employer hired.

What matters is whether the work incident caused or contributed to the condition being claimed. On the related question of reducing an award for a prior condition, the distinction that does the work is between a condition that was merely present and one that was actually disabling — covered on our page about apportionment between claims.

Then comes the second fight: keeping the benefits

Establishing the claim is half of it. These cases run long — months of wound care, repeat hospitalizations, a wound that improves and then deteriorates again — and benefits are lost in the gaps.

Where a disability has not been classified as permanent, there is no presumption or inference that the disability is continuing. The attending physicians carry the burden of submitting up-to-date medical evidence that it is (Matter of Virtuoso v Glen Campbell Chevrolet, Inc., 66 AD3d 1141 [2009]). Board regulation requires progress reports on ongoing treatment at intervals of no more than 90 days.

The practical consequence is blunt. A stretch of months with no filed report becomes a stretch of months with no award, even where the worker was plainly still disabled throughout it. And a report that describes the wound in detail but never states a degree of disability does not fix it — which is the subject of our page on why your medical reports must state a degree of disability.

If this is happening to you

  • Report it the same day, even if it seems like nothing. A puncture you barely noticed is still an accident, and the report is what anchors everything later.
  • Say you stepped on something if you did — even if you did not feel it. Tell the emergency room you were at work and describe the floor you were working on.
  • Get to a hospital the same day symptoms start. Fever, chills, feeling unwell and grey after a shift is not the flu when you are diabetic and on your feet.
  • Tell every provider it is a work injury, every visit.
  • Keep follow-up appointments inside the 90-day window, and ask at each one whether a report with a degree of disability is going in.
  • Do not let a denial end it. These claims are routinely denied at the outset and established later on the medicine.

Talk to a New York workers’ compensation attorney

If you are diabetic and a minor injury at work turned into an infection, a hospital stay, or surgery, do not assume your diabetes disqualifies you. It usually does the opposite — it explains why something small became something serious.

Call (718) 701-2776. The consultation costs nothing, and you will speak with me.

We handle workers’ compensation claims for injured workers throughout the five boroughs and across New York State. If we don’t recover money for you, we don’t get paid.

Nothing on this page is legal or medical advice about your own claim. Causal relationship is decided by the Board on the medical evidence in the record, and every case turns on its own facts.