201-880-7213

LOIS Wins in Fraud Case Where Claimant Failed to Disclose a Prior Injury

The claimant, was injured on June 18, 2021, when he was stacking and restacking the bread boxes and he felt a pop in his left shoulder. The claimant returned to work, full duty, for the same employer on August 23, 2021.

At a hearing on January 30, 2023 the claim was established to the left shoulder with an AWW of $1,043.49. LOIS attorney Adam Lowenstein questioned the claimant about prior injuries. The claimant disclosed a February 19, 2007 injury to the shoulder, but stated that another prior September 23, 2013 accident involved the left knee only. Both accidents occurred in Pennsylvania. The claimant was directed to provide a HIPAA within 30 days. Both sides were directed to produce permanency reports within 75 days and the case was marked no further action.

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LOIS Attorney Secures a Disallowance for a Construction Case

LOIS attorney Meisha Powell succeeds in persuading the workers’ compensation Law Judge that the Claimant formulated an accident on a large construction site, by casting doubt in the claimant’s version of the events. Immediately after the case was referred to attorney Powell, witnesses were contacted so that relevant information could be gathered regarding the claimant, and this alleged accident. Attorney Powell and her team was able to determine that the claimant did not suffer a work-related accident on the construction jobsite that was covered by the Carrier’s (OCIP) site specific policy.

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LOIS Obtains Disallowance on Lack of Notice Case

LOIS attorney Alexa Cintron was successful in arguing for a disallowance of a 2022 claim, where the claimant alleged he sustained injuries to his back, left hip and tailbone. However, the Claimant failed to provide proper notice to his employer pursuant to Section 18 of the Worker’s Compensation Law. Attorney Cintron was able to obtain favorable testimony from both the Claimant and employer witness, which led the Law Judge to disallow the claim, stating that the Claimant’s inconsistent testimony did not satisfy the element of notice.

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LOIS Litigation Team Uncovers Crucial Fact to Secure Trial Victory Without Producing Lay or Expert Witnesses

LOIS Partner Christian Sison and Paralegal Brianna Nicolas were asked to handle a case, A.A. v H.S.C. LLC, wherein the claimant filed a claim for benefits 1 year after the accident occurred and sought medical treatment 2 years thereafter. In a pre-hearing conference, the Judge precluded the Employer and Carrier from producing certain types of evidence. Although LOIS appealed that decision, Christian and Brianna were undeterred in their efforts to defend the claim.

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LOIS Obtains Disallowance and Fraud Finding based on Claimant’s Concealment of Prior Injuries

The Claimant was a delivery man in his position for over thirty years. Over the course of those thirty years, the Claimant filed over ten claims against the same employer, most of which were established. The Claimant previously brought a knee claim which was disallowed within the last year, which Lois Law Firm successfully defended and avoided total knee replacement for both knees. Concurrently, the Claimant brought a claim for the bilateral wrists, alleging both bilateral wrist injuries and bilateral carpal tunnel syndrome.

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LOIS Wins on Section 29(5) Violation

In a claim with significant future exposure, which was established for multiple work-related injuries arising from a motor vehicle accident, Lois Law Firm trial attorney Hannah E. Bacon Esq., with assists from Partners Christopher J. Major, Esq. and Joseph N. Melchionne, Esq., and Paralegals Nicholas Fortino and Loriana Diaz, successfully argued that the claimant settled his third-party civil lawsuit without the Workers’ Compensation carrier’s consent in violation of Workers’ Compensation Law §29(5) (“WCL §29(5)”) resulting in a Memorandum of Board Panel Decision finding that the claimant is disqualified from receiving any future Workers’ Compensation benefits (including both medical and indemnity).

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LOIS Subrogation Team Secures 100% Loss Transfer Award Despite Prior Finding of No Liability

In a case where two claimants were injured in the same motor vehicle accident and the adverse automobile liability insurance carrier denied both loss transfer claims on the basis of a prior arbitration award, Lois Law Firm Partner Christopher Major, Esq. and Senior Paralegal Jenifer Andrews were able to obtain full reimbursement via intercompany loss transfer arbitration on both claims. There was a prior third-party settlement with the at-fault driver that was inadequate to compensate the claimant’s damages, resulting in the claimant making an application for underinsured motorist benefits (SUM/UIM) against the UIM carrier. While that claim was pending, the UIM carrier sought intercompany loss transfer against the adverse carrier for property damage sustained in the accident. In that arbitration, the arbitrator ruled that the case was “word vs. word” and, therefore, there was inadequate evidence of liability on the part of the adverse carrier’s insured.

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LOIS Obtains Labor Market Attachment Win Despite Non-Payment of Awards

LOIS Partner Christian Sison was asked to defend a self-insured employer in a difficult case (K.S. v R.G., Inc.), wherein the claimant sustained burns after a pilot light on a grill malfunctioned. As the claimant’s rehabilitation progressed, LOIS secured a judicial ruling that the claimant had a temporary partial disability that required the claimant to mitigate the damages by looking for work within those restrictions or pursuing vocational rehabilitation. However, LOIS also was able to suspend indemnity benefits because of the claimant’s separate failure to produce medical evidence to substantiate wage loss benefits.

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