LOIS Associate Kristine Rosales and Paralegal Andrea Hayles obtained a disallowance in a New York Workers’ Compensation construction case involving a Claimant who failed to establish accident, notice, and causal relationship. During trial, Attorney Rosales impugned the Claimant’s credibility by bringing to light the different mechanism of injuries that he reported in two versions of the C-3, the initial medical report, and the subsequent medicals from his treating doctors. Attorney Rosales also zeroed in on the named witnesses in the first C-3 but then excluded in the subsequent one. Attorney Rosales also presented rebuttal witnesses who confirmed that the Claimant was not injured on the date of the accident – and even rode his bike home.
Attorney Rosales argued that the claim should be disallowed based on the inconsistent mechanism of injuries reported, the denial of any injuries in the initial medical report, and the contradictory accident reported to subsequent treating doctors. Attorney Rosales argued that these inconsistencies support a finding of no causal relationship. The Claimant also failed to establish notice, she argued: the rebuttal witness supported the fact that the Claimant was fabricating the claim to obtain Workers’ Compensation benefits. Importantly, the initial medical report was five months after the alleged accident. The Law Judge upheld the position of Attorney Rosales and disallowed the claim. As a result of this favorable outcome, the Carrier is not liable for any incurred bills or any indemnity benefits associated with the disallowed claim.
