News & Articles

In a case where a 7-year-old decision found a claimant to have a permanent total disability, LOIS Partner Christian Sison requested a reclassification of the claimant based on covert surveillance that discovered the claimant’s ability to perform activities that were initially deemed impossible. The claimant was previously found to have an exertional ability that limited her to perform sedentary work. However, evidence produced after the permanent disability finding indicated otherwise, with the claimant seen performing various household activities without the use of the assistive device previously alleged to have been necessary.

The claimant was injured on October 10, 2019, while stepping on stairs to a truck, the stairs gave out causing him to fall. The claim was established for a work related injury to the left knee. The claimant was laid off as of April 2, 2020 due to COVID-19 and lack of work, not related to the injury sustained in the accident. Therefore, no awards were issued for lost time.

Lois Law Firm recently won a Board Panel Decision which implemented a lifetime ban on future indemnity benefits as a result of the claimant’s commission of fraud within the meaning of WCL § 114-a. The claim was previously established for injures to the head, neck, back post-concussion syndrome and a consequential left clavicle injury resulting from a 2013 accident.

The Claimant was a delivery man in his position for approximately eight months at the time of the alleged injury. The Claimant alleged in his initial C-3.0 that he suffered back pain, but was not sure how it happened. He alleged that he woke up the next morning and could barely move. He assumed it must have been because of his job duties. He told his doctor about two months later that the pain began five months earlier and that there was no inciting incident. However, as the Claimant began to treat with the same doctors, he eventually stated that an acute accident occurred, that he tripped while loading boxes, fell, and injured his lumbar spine. The employer denied the claim, as the Claimant failed to provide notice of the accident until over two months after the alleged accident. Further, despite denying prior treatment to the lumbar spine, the Claimant had a history of sciatica.

Claimant was involved in a July 11, 2021 work-related accident established for injury to the right shoulder. No prior shoulder injuries were disclosed in the completed C-3. Claimant reported to her treating physician that she underwent a previous right shoulder MRI but could not remember involvement in any significant injury that precipitated the MRI. Upon presentation to the IME physician, Claimant reported medical conditions and surgeries dating back to the 1980s but reported no prior right shoulder injury or medical care.

Attorney Anthony Iler successfully obtained a complete disallowance at trial despite the presence of an IME conceding causal relationship for injuries to the neck, back, left wrist and left ankle. The claimant alleged he was injured at a construction site in February of 2021. LOIS initially raised all available defenses and argued that the claimant was the employee of a demolition sub-contractor rather than its insured client. Further investigation revealed substantial “red flags” pointing to the fact that no accident actually occurred.