Lois Law Firm successfully obtained a fraud penalty against a claimant, which resulted in the claimant being barred from receiving any workers’ compensation indemnity benefits for a period of 4-years, as a result of the claimant failing to disclose prior injuries involving overlapping body parts. The claimant suffered neck, back, left shoulder and post-concussion injuries as a result of her work accident, but on repeated occasions she denied having any prior injuries to the same body parts, despite suffering similar injuries in a personal motor vehicle accident 1 ½-years prior to her work accident.
Lois Law Firm, as a standard practice on all files, performs investigations to determine if claimants have prior claims involving injuries to similar body parts. Attorney, Ian Haberstro, with the assistance of paralegal, Uma Mistry, performed an investigation into this claimant’s past medical history via a review of an ISO report and thereafter, associated subpoenaed medical records, which uncovered that 1 ½ years prior to her work accident, the claimant had been involved in a personal motor vehicle accident that resulted in injuries to the neck, back, shoulders, and associated headaches, for which the claimant filed a third-party lawsuit, underwent diagnostic studies, received physical therapy and acupuncture treatment for nearly 8-months, and had 4-months lost time from work. Upon discovery of the prior motor vehicle accident, Attorney Haberstro reviewed the records in the Workers’ Compensation Board file and uncovered that the claimant failed to disclose her prior accident and injuries in her C-3, to her own treating providers, to the employer’s IME doctor, as well as failing to disclose the prior injuries to her own attorney or to the Law Judge. Accordingly, Attorney Haberstro raised fraud based on the claimant’s denial of her prior injuries on multiple occasions, which resulted in the case being set for trial of the claimant.
At trial, Attorney Haberstro, was successful in obtaining multiple concessions from the claimant regarding her repeated failures to disclose her prior motor vehicle accident and associated injuries and treatment. Upon conclusion of the claimant’s testimony, Attorney Haberstro, directed the Law Judge to all relevant documentation in the WCB Board file, which exposed the claimant’s repeated fraudulent misrepresentations denying any prior injuries. Based on the record, we were able to argue that the claimant had committed fraud pursuant to Workers’ Compensation Law Section 114-a by repeatedly fraudulently denying any prior injuries to the same body parts claimed in her workers’ compensation case, despite having a personal motor vehicle accident only 1 ½ years prior that caused injury to all the same sites. It was argued that it would have been impossible for the claimant to forget her prior accident and injuries, considering the prior accident was only 1 ½ years before the current work accident, and the claimant had received months of treatment, had lost months of time from work, and even filed a personal injury lawsuit in connection with the prior motor vehicle accident. The Law Judge agreed and concluded that the claimant made a “willful misrepresentation” by failing to disclose her prior accident and injuries. The Law Judge found that the claimant violated Workers’ Compensation Law Section 114-a and imposed a 4-year ban against the claimant from receiving any indemnity benefits.
This WCL 114-a fraud finding was made possible by Lois Law Firm’s standard practice of investigating all claimants’ past claims and medical histories, which frequently uncovers fraudulent misrepresentations made by claimants concerning their undisclosed prior accidents and injuries.
