LOIS Associate Tomer Lehr and Paralegal Loriana Diaz successfully achieved a nominal settlement in a New York Workers’ Compensation claim. The matter involves a controverted claim with significant exposure and IME’s concession of causality. A diligent review of the initial hospital records revealed that the Claimant reported a slip and fall in the shower a day before the accident of record. Although the claim initially appeared dormant, Claimant’s counsel later sought to establish basic issues and lost time benefits. Around the same time, Claimant filed an FMLA application for an unrelated medical condition that resulted in lost time, suggesting that the counsel may not have been aware of this development.
At a hearing requested by the Claimant, PFME was found for the left knee. Attorney Lehr maintained the denial and argued that the injury was unrelated as it occurred at home. Thereafter, Attorney Lehr raised a Section 114-a violation based on Claimant’s pursuit of lost time benefits while on leave for an unrelated medical condition. Although the Law Judge directed further development of the record and IME conceded causality, substantial inconsistencies remained, including the treating provider’s lack of awareness of the prior shower accident. After submitting written summations highlighting these issues and before lay testimony was taken, the claimant accepted a nominal settlement. As a result of this favorable outcome, Carrier’s exposure was significantly reduced.
