Winning Results

LOIS Prevails in Fraud Trial; Wins Permanent Penalty

Lois Law Firm secured a fraud penalty against a claimant, which resulted in the claimant being permanently barred from receiving any Workers’ Compensation benefits because of his failure to disclose work-activities and giving false testimony at prior hearings. LOIS attorney, Dan Gillis, was able to achieve this though effective cross-examination of the claimant and claimant’s witnesses along with a persuasive argument that the claimant failed to disclose his work-activities after the accident and outright denying any such work-activities at prior hearings and to the Carrier’s IME physicians.

The claimant, a construction foreman, alleged injuries to his lower back and foot after he stepped on a rock, rolled his right ankle, and felt a sharp pain in his back. After the claimant returned to work in a part-time capacity and requested reduced earnings, Attorney Gillis, with the assistance of paralegal Melissa Gannon, learned the location of the claimant’s new employer and subpoenaed a copy of the claimant’s personnel file. Once those records were received, an investigation was performed into the claimant’s internet and social media activity. The results of this social media and internet search revealed that the claimant was still active in a personal business selling and breeding animals, including attending conventions, featured in videos giving tours of a facility located within his personal residence while wearing a company t-shirt, and was listed as the contact person on social media sites including an on-line marketplace. Following this discovery and at a hearing to address the claimant’s alleged reduced earnings, Attorney Gillis raised fraud based upon a failure to disclose work-activities, which resulted in the case being set for trial.

At trial, Attorney Gillis was successful in obtaining multiple concessions of the claimant including his repeated failures to disclose work activities to the Carrier and Workers’ Compensation Board and his cell phone number, given to the Workers’ Compensation Board, was used as the contact number for the business after the accident. In addition, that the claimant created the online marketplace website, was attending conventions as a representative of the company, and was also featured in online videos as a representative of the company. Further, Attorney Gillis was able to secure concessions from the claimant’s own witnesses including that the animals to be sold were in the claimant’s personal residence, the claimant did attend conventions as a representative of the company after his accident, and prices of the animals could be as much as several thousand dollars.

Upon conclusion of the testimony, Attorney Gillis directed the Law Judge to the claimant’s prior testimony wherein he outright denied any work activities or involvement with a business. In addition, Attorney Gillis directed the Law Judge’s attention to the previous IME reports that documented that the claimant denied work activities of any kind. Based upon the record, Attorney Gillis argued that the claimant violated Worker’s Compensation Law 114-a by denying any work-activities to the previous Law Judge and the Carrier’s IME physicians despite being assessed with a total disability after the accident, attending conventions speaking to prospective customers, and acting as a representative of the company in videos posted online. The Law Judge, in a Reserved Decision, agreed and concluded that that the claimant, despite denying any involvement in work-activities under oath at prior hearings, was holding himself out to be part of the business while attending conventions, giving tours, and maintaining complete ownership of the business. Thus, the Law Judge found that the claimant violated Workers’ Compensation Law Section 114-a and, in addition to the rescission of all indemnity awards since the accident date, imposed a permanent disqualification from all future indemnity awards given the egregiousness of the fraud committed.

Download the New York Workers’ Compensation Law Handbook

Download Our New York Workers’ Compensation Law Handbook

The 2023 edition of Gregory Lois’ practical, up-to-date, and easy-to-understand guide to workers’ compensation claims in New York.

This book is designed for employers, attorneys, claim adjusters, physicians, self-insured employers and vocational rehabilitation workers.

Download Now

Learn More About New York Workers’ Compensation Defense at LOIS

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.

Learn More

Get articles delivered to your inbox, once a month.

Subscribe Today!