New 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.
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→
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→
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.
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 .
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.