LOIS Associate Natalia Verde secured a disallowance in a New York Workers’ Compensation claim pertaining to a home health aide fall near a store. The Claimant reported an injury which occurred at 2:00 p.m. when she went to the store to pick up food for her client when she tripped and fell on the sidewalk. Injuries alleged were the left ankle, bilateral knees, bilateral hips, bilateral shoulders, neck, and low back. At the hearing, Verde confronted the Claimant with initial EMS and hospital records, as well as photographs of the scene, which contradicted the Claimant’s medical reports. The Claimant was also confronted on the discrepancies between her Employee Claim Form C-3, the incident report, and the general timeline of events. Two employer-witnesses also testified, one of which testified as to the incident report (which was completed at 10:30 p.m.) and the other testified to the fact that notice was not orally provided.
The Law Judge issued a Reserved Decision disallowing the claim in its entirety. The Law Judge relied on the numerous inconsistencies in the Claimant’s testimony and the evidence. Despite the medical reports opining that the Claimant’s injuries were causally related to her work, the Law Judge held that since the medical reports relied on the Claimant’s self-reported history and since the Claimant was unreliable, the medical reports were therefore also unreliable. The Law Judge also focused on the fact that the Claimant alleged a significant injury that required ambulance transport to the hospital; however, there was a several time gap between the alleged injury time and the call for an ambulance. The claim was disallowed and closed, as the Claimant was not credible and failed to demonstrate a causally related accident arising out of and in the course of employment.
