LOIS Associate Rachel Shapiro secured a disallowance of a New York Workers’ Compensation claim where the Claimant was found to have masked his prior unrelated injuries with an alleged work-related injury. The Claimant alleged to having an at work injury to his back per his first C-3 after trying to lift an overweight patient that fell in the shower while working. This was alleged to have taken place on June 30, 2023. The Claimant’s first medical report, dated October 14, 2023, indicated a reported date of accident as May 5, 2023. An amended C-3 was filed, alleging a new date of accident of May 13, 2023. Both Forms C-3 report that the Claimant had “no prior treatment to his back before this accident.” The Claimant denied prior treatment to his back to his physicians, on his C-3s, and to the IME. At the hearing, Shapiro nevertheless requested for HIPAA releases, but the Claimant’s counsel refused, going as far as filing a letter memorializing that the Claimant did not seek treatment with any physicians and, therefore, is unable to produce any HIPAA releases for prior treatment.
Shapiro obtained an ISO claims search of the Claimant, which indicated that the Claimant had a prior motor vehicle accident on March 20, 2023. Upon further investigation, there was extensive treatment to the back as a result of the accident, including MRI studies, EMS studies, physical therapy, and epidural injections. There was also indication that the Claimant had prior back surgery in December 2022. Of note, the Claimant had right shoulder surgery on July 28, 2023 – just three days after he allegedly stopped working because of this injury to his back. At the trial, the Claimant testified that he had “no prior treatment to his back before May 13, 2023,” despite the prior back treatment in the Board file. Shapiro argued that the Claimant’s testimony was incredible in light of the totality of the record and the severity of the prior treatment, and the Law Judge issued a Reserved Decision disallowing and closing the claim. The Carrier in this case is not liable for any indemnity or medical benefits as a result.
