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WINNING RESULTS: LOIS Secures Suspension of Benefits for Failure to Disclose Prior Accidents and Injuries

In a claim established for the low back and left ankle, LOIS raised WCL Section 114-a for the claimant’s failure to disclose prior injuries and related accidents from 2009, 2003 and 2002.

On the day of the fraud trial, August 12, 2022, the claimant’s attorney filed an amended C-3 to the Board which noted the prior accidents and injuries to her back. At the hearing, the claimant admitted that she was involved in the prior accidents, as Lois Attorney Michael O’Beirne raised during the pre-trial conference. Claimant also admitted that in the 2009 and 2003 accidents she received injuries to her back. She testified that she discussed the prior accidents and injuries at her first IME and the doctor told her that she did not have to include them in her questionnaire because they were so old. This was also the reason she gave for checking “no” on the questionnaire at the second IME when asked if she was involved in prior accidents.

Defense Counsel directed the Law Judge’s attention to the first IME report in which the IME doctor noted that the claimant did not discuss whether she was involved in any prior accidents or suffered any prior injuries. We then directed the Law Judge’s attention to the second IME report which indicated the claimant told the IME doctor that she was not involved in any prior accidents. As such, the Law Judge did not believe the claimant’s excuse(s) as her testimony was in direct contradiction to the IME reports.

On summation, LOIS argued that the claimant violated WCL Section 114-a and mandatory and discretionary penalties should be imposed against the claimant for her failure to disclose her prior accidents and related injuries on her original C-3, to her treating doctors and to the IME doctor. The Law Judge decided in the employer’s favor and found the claimant violated WCL Section 114-a. The Law Judge imposed a mandatory penalty from November 21, 2021 to August 11, 2022 and a discretionary penalty barring the claimant from any future indemnity benefits.

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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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