Winning Results

LOIS Secures Fraud Finding Due To Claimant’s Symptom Magnification

LOIS Partner Christian Sison and LOIS Paralegal Taylor Rodriguez were successful in obtaining a fraud finding after a lengthy set of trials in a New York Workers’ Compensation case. The Claimant was a hotel housekeeper that requested wage replacement benefits after having worked for a long period of time. Given that the requested benefits coincided with the start of the 2023 summer season, covert surveillance was initiated.

The surveillance videos proved that the Claimant used an assistive device only when presenting herself to medical appointments. It also displayed the Claimant’s extensive ability to drive when she denied the ability to do so. Sison prepared a fraud defense by meticulously comparing the Claimant’s complaints with the activities shown on surveillance video. Pressed with the evidence, the Claimant admitted that she was the individual caught on surveillance. After trial, the Judge rejected the Claimant’s “good day / bad day” argument and agreed with Sison that the Claimant presented herself in a way that augmented or exaggerated her disability.

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Download Our New York Workers’ Compensation Law Handbook

The 2023 edition of Greg 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.

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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.

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