LOIS Obtains Disallowance by Relying on Prior Credibility Finding

LOIS Associate Natalia Verde obtained a disallowance in a New York Workers’ Compensation case as it related to the lumbar spine. The claim was accepted for the left knee pursuant to the initial treatment records which confirmed that the Claimant injured her knee when she slipped and fell at work. Verde raised a WCL Section 114-a defense in light of covert surveillance showing the Claimant ambulating without crutches or braces, despite telling her treating doctor that she could not ambulate and the doctor subsequently opining that she was 100% temporarily disabled. Although the Law Judge did not find a WCL Section 114-a violation, the Law Judge noted that should the Claimant seek any indemnity benefits in the future, the issue of fraud would be ripe as the Claimant “grossly exaggerated her symptoms and misrepresented her condition to her medical provider.” The Claimant then raised the lumbar spine as an injury. Verde raised all issues in controversy, and, following depositions, highlighted that the Law Judge’s prior warning. In addition to relying on the Claimant’s symptoms magnification and misrepresentation of her condition, Verde also relied on the inconsistencies in the Claimant’s symptoms and mechanism of injury to show that any claim for the lumbar spine was not supported by the record. The Law Judge ultimately found the IME doctor more reliable than the Claimant’s treating doctor and found that the Claimant’s credibility was already compromised, disallowing the back. As a result, the exposure on the claim was significantly reduced.