Winning Results

LOIS Obtains Permanent Disqualification Result Due to Claimant’s Omission

LOIS Senior Associate Stephen McLinden secured a favorable WCL Section 114-a finding, resulting in a permanent disqualification for all future indemnity benefits. McLinden obtained this finding by highlighting the material misrepresentations and omissions that the Claimant characterized as not understanding the “fine print.” The Claimant in this matter received a permanency award in SLU in June 2020 after achieving maximum medical improvement. Thereafter, the Claimant began treating with a new surgeon, who requested for surgery in 2021 and 2022. In those requests, the Claimant first disclosed a 2007 motor vehicle accident for which the Claimant underwent previous physical therapy and injections. It was upon this admission, McLinden argued, which was never disclosed between the date of accident and the time she received her SLU award, that a material misrepresentation had occurred.

This had the potential to break open a previously “closed” claim with new exposure. On appeal to the Board Panel, the Claimant was found to have violated WCL Section 114-a, fully disqualified including a discretionary penalty barring her from any future replacement benefits. “We find that the Claimant did not provide a credible explanation for this discrepancy during her testimony,” noted the Board Panel, adopting McLinden’s arguments, “As such, we find that the Claimant has violated [WCL Section] 114-a and a discretionary penalty of permanent disqualification is imposed based on the Claimant’s egregious conduct of failing to disclose her prior motor vehicle accident on her C-3 form and to the IME doctors in her Workers’ Compensation case.” In light of this decision, the Claimant will not be entitled to any indemnity benefits (temporary and permanent awards), greatly diminishing the exposure.

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New York Workers’ Compensation Defense at Lois Law Firm

We represent insurance carriers, self-insured employers, third party claim administrators, and employers before the New York State Workers' Compensation Board. We handle cases from cradle-to-grave. We want to be by your side, moving cases aggressively to closure from the start of litigation all the way through to settlement.

We only assign one attorney and one paralegal to each case. This means that your team members always have one contact to go to for any questions. We do not have 'hearing attorney' or a 'negotiation attorney' or 'appeal department' or anything else! All of our attorneys handle all of those roles – meaning cases are not 'passed around' as they move through the litigation process. Your risk professional or adjuster always knows who is assigned – because the attorney does not change.

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