LOIS Obtains Disallowance of Sites and a Lifetime Ban; Claimant Misrepresents Prior Car Accident Treatment

LOIS Senior Associate Anthony Iler and Paralegal Stevo Bubalo proved a severe WCL Section 114-a violation in a New York Workers’ Compensation claim. The claim was established for injuries to the low back, left shoulder, traumatic brain injury, and post-concussion syndrome relating to an alleged June 12, 2023z workplace accident. Iler and Bubalo were diligent in their pursuit of the Claimant’s prior medical records concerning a 2021 motor vehicle accident. At the hearing, the Claimant testified that he did not disclose his prior accident involving his neck when completing his Employee Claim Form C-3.0, because he was more concerned with other body parts that were giving him more pain. These sites included the low back. However, upon cross-examination, the Claimant was confronted with the fact that he also had a series of epidural steroid injections to the low back relating to the prior motor vehicle accident. He offered no compelling explanation as to why his prior back injury and the full extent of his neck treatment were not disclosed to either his doctors or the Carrier’s consultant. Following the Claimant’s testimony, the Law Judge was persuaded by Iler’s arguments and found that the Claimant committed fraud under WCL Section 114-a. The conduct was found to be so egregious to warrant the implementation of a lifetime ban on future indemnity benefits. Moreover, based upon the prior records, LOIS was successful in having the claim disallowed for injuries to the neck, right, knee, and right shoulder.