201-880-7213

Trial Win: Claimant Committed Fraud While Pursuing Benefits in New York

On March 15, 2019 LOIS attorney Joseph Melchionne was successful in obtaining a favorable Reserved Decision determining that the carrier does not have a legal obligation to provide the claimant and the court with covert video surveillance reports during litigation of fraud under WCL Section 114(a). At trial, Melchionne argued that the claimant violated Section 114(a) and committed fraud because covert video surveillance was obtained that revealed the claimant performing masonry work while maintaining to his doctors that he was unable to even perform the simplest activities of daily living. The claimant’s material representations to his doctors compelled his treating physicians to issue medical reports opining that the claimant was totally disabled. In this case, the court determined that the claimant’s conduct was so egregious that not only was it determined that the claimant was ineligible to receive indemnity benefits for prior periods of lost time, but the court also utilized the discretionary penalty to disqualify the claimant from receiving any future indemnity benefits.

Case Information

Download the New York Workers’ Compensation Law Handbook

Download Our New York Workers’ Compensation Law Handbook

The 2023 edition of Gregory 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.

Download Now

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.

Learn More

Get articles delivered to your inbox, once a month.

Subscribe Today!