Category Archives: Fraud

Is Income Earned Through Criminal Activity Fraud under Section 114-A?

Joseph MelchionneNew York injured workers are compensated through their employer’s workers’ compensation insurance policies for all lost time and medical treatment that is causally related to their work-related injury. However, an injured worker can be precluded from receiving continuing and prior benefits if he or she acts fraudulently for the purpose of obtaining such benefits.

New York Workers’ Compensation Law (WCL) Section 114-a governs fraud and describes significant penalties for those who are caught committing fraud such as a permanent ban on their eligibility to receive indemnity benefits and/or a permanency award. Continue reading Is Income Earned Through Criminal Activity Fraud under Section 114-A?

Raising Fraud: No Prior Disclosure Needed for Social Media Posts in New York

What happens when the carrier provides publicly available social media evidence as a basis for fraud and the claimant subsequently makes the social media posts private?  LOIS was recently successful in arguing that prior disclosure of social media evidence obtained by the employer is not required and that an employer/carrier can introduce “private” social media evidence into the case and using it to cross-examine the claimant. Continue reading Raising Fraud: No Prior Disclosure Needed for Social Media Posts in New York

Fraud – Third Fridays Podcast

Today’s topic is fraud. Attorney Christian Sison welcomes New York defense litigator Usra Hussain to the show to discuss fighting fraud in New York workers’ compensation claims. Can employers prove that claimants “knowingly” violate Section 114-a? Is it always beneficial to raise fraud at the outset of a claim? The episode ends with Usra taking her turn at “Guess the Outcome”! Continue reading Fraud – Third Fridays Podcast

False Statements Made in New York State Workers’ Compensation Claims Can Lead to Forfeiture of Right to Receive Future Benefits

Joseph Melchionne
Joseph Melchionne, Esq.

New York State workers’ compensation fraud may take many forms and result in a myriad of consequences.  WLC § 114(a) not only governs circumstances of fraud but also describes significant penalties for those who are caught committing fraud such as a permanent ban on their eligibility to receive indemnity benefits and/or a permanency award.

WCL § 114(a)  directs that a claimant is to be penalized if he or she “knowingly makes a false statement or representation as to a material fact . . . .” in furtherance of receiving workers’ compensation benefits. This mandatory penalty is a forfeiture of all compensation that is directly attributed to the false statement.  Workers’ compensation fraud penalties only apply to indemnity benefits and permanency awards, paid medical benefits are not subject to forfeiture in a fraud determination. See Jacob v. New York City Transit Auth., 26 A.D.3d 631, 809 N.Y.S.2d 618 (App. Div. 2006); Matter of Robinson v. Interstate Natl. Dealer, 50 A.D.3d 1325 (3rd Dept. 2008).

Pursuant to WCL § 114(a):

“If for the purpose of obtaining compensation pursuant to section fifteen of this chapter, or for the purpose of influencing any determination regarding any such payment, a claimant knowingly makes a false statement or representation as to a material fact, such person shall be disqualified from receiving any compensation directly attributable to such false statement or representation.”
Continue reading False Statements Made in New York State Workers’ Compensation Claims Can Lead to Forfeiture of Right to Receive Future Benefits

Is this Workers’ Compensation Claim Fraud in New York?

  1. Claimant denies having gainful employment while collecting temporary disability benefits. He actually started up a small business, but the business lost money.
  2. Claimant says he applied for jobs at 34 different businesses while seeking benefits. The employer performed its own follow-up search and learned he applied for only two (2) jobs.New York Workers' Compensation law 2017
  3. Claimant lying about his physical restrictions to our IME doctor
  4. Concealing volunteer work while “too disabled” to do your regular job?
  5. Caught selling street drugs while collecting workers’ compensation benefits?
  6. Claimant first admits to working, but her attorneys later state she isn’t. Claimant later found working seasonally while collecting benefits.
    Continue reading Is this Workers’ Compensation Claim Fraud in New York?

Appellate Division Rules Misrepresentations by the Claimant to an IME Is Sufficient for Fraud Finding

In New York, pursuant to Workers’ Compensation Law § 114-a (1), a claimant may be disqualified from receiving workers’ compensation benefits “[i]f for the purpose of obtaining compensation . . . or for the purpose of influencing any determination regarding any such payment, [he or she] knowingly makes a false statement or representation as to a material fact.”    A fact is “material” if it is “significant or essential to the issue or matter at hand,” and it need not be demonstrated here that claimant received compensation to which he was not otherwise entitled or that he did not sustain a compensable injury (Matter of Losurdo v Asbestos Free, 1 NY3d 258, 265 [2003].

Jeremy Janis
Jeremy janis, Esq.

Recently the Third Department of the New York Appellate Division entertained an appeal in which the claimant was disqualified from receiving future benefits and forced to pay back past benefits as a result of violating Workers’ Compensation Law § 114-a, therefore committing fraud.  The case, Matter of Poupore v Clinton County Highway Dept. 2016 NY Slip Op 03037 was decided on April 21, 2016.  In this case, the penalty imposed by the Law Judge and the Board Panel was upheld on appeal.

Continue reading Appellate Division Rules Misrepresentations by the Claimant to an IME Is Sufficient for Fraud Finding