LOIS Associate Rachel Shapiro obtained a disallowance with covert surveillance and accident recreation videos in a New York Workers’ Compensation claim. After being hired with the Employer only two days prior, the Claimant reported having an alleged accident where her chair was caught in a cord, causing the chair to fall. Surveillance was obtained thereafter of the Claimant while out of work purportedly due to the alleged accident, which included attending a graduation ceremony and en route to a birthday trip in Jamaica. This Claimant also had extensive prior claims, which included a mechanism of injury of tripping over a wire and three prior motor vehicle accidents. The Independent Medical Examiner here conceded causal relationship, given the history rendered and the treatment; the Carrier nevertheless controverted the claim in light of the surveillance and history of prior accidents. Meanwhile, the Employer conducted an investigation of the alleged accident, which included a recreation of the alleged mechanism of injury. A video was taken of this recreation.
Attorney Shapiro presented the surveillance footage, the investigation video, and the investigators, countering the Claimant’s allegations and testimony that she used a wheelchair at the airport for the Jamaica travel. The Claimant’s counsel argued that the IME conceded to causal relationship and suggested that the claim was a frivolous controversy. Shapiro argued that the claim should be disallowed and closed in light of the totality of the evidence, noting that the employer’s video with regard to its investigation showed that the mechanism of injury alleged was not possible. Shapiro highlighted the inconsistencies in the medical record, as well as the Claimant’s testimony and the covert surveillance. Based on the defenses presented, the Law Judge ultimately disallowed the claim, closing the matter. As a result, the Carrier is not liable for the alleged claimed indemnity or medical benefits.