Category Archives: Fraud

Video: Employee Status In New York Workers’ Compensation

In this video, Greg Lois provides an overview of employee status in New York workers’ compensation cases! This video is from a live presentation on April 20, 2020.

In this video, Greg provides answers to common questions, such as:

  • Recent case law decisions on employee status that answer the question, “Is the Claimant My Employee?”
  • Tactical and strategic considerations in challenging employment
  • Consistent issues regarding employment status, including independent contractor status, in New York workers’ compensation cases.
Continue reading Video: Employee Status In New York Workers’ Compensation

Video: Fraud Case Updates New York Workers’ Compensation

In this video, Greg Lois provides an overview of claims fraud in New York workers’ compensation cases! This video is from a live presentation on March 16, 2020.

In this video, Greg provides answers to common questions, such as:

  • Recent case law decisions on fraud.
  • Tactical and strategic considerations in raising fraud.
  • Red flags for fraud in New York workers’ compensation cases.
Continue reading Video: Fraud Case Updates New York Workers’ Compensation

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