Misrepresentations of rodeo work trigger application of fraud provision

A workers' compensation board panel held that the worker made fraudulent statements about his volunteer activities and misrepresented his condition to the independent medical examining doctor.

Case name: Addeco, 109 NYWCLR 78 (N.Y.W.C.B. Panel 2009).

Ruling: A workers' compensation board panel held that the worker made fraudulent statements about his volunteer activities and misrepresented his condition to the independent medical examining doctor.

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What it means: If a worker's behavior: 1) demonstrates a pattern of intentionally attempting to mislead the board with regard to the extent of his activities; 2) misleads his physicians and the IME doctor regarding his medical status and abilities; and 3) these misrepresentations are material and made for the purpose of influencing a decision in his case, he may be disqualified from receiving workers' compensation benefits and subject to penalties for fraud.

Summary: A panel found that a worker intentionally attempted to hide the extent of his volunteer activities as part of a ring crew at a rodeo and that he misrepresented his condition to an IME doctor so that he could receive workers' compensation benefits. The panel found the worker was involved with the rodeo "far more than two hours per day," as he had testified. The panel found that his activities included setting up poles numerous times during a weekend, setting up the rings, and rolling barrels with his feet. It concluded that the worker showed a pattern of behavior to purposely hide the extent of his activities and that his denial of performing any volunteering activities was not an innocent error but rather, was intentional.

The worker denied performing any work activity, including volunteering. The panel disagreed with a workers' compensation law judge that the worker's statements were not intended to mislead and that the WCLJ should have expanded the scope of inquiry to include statements the worker made before the board.

The panel found that based on the serious and egregious nature of the worker's misrepresentations and false statements, it permanently disqualified the worker from receiving workers' compensation benefits and held that he would be subjected to penalties for fraud.

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July 23, 2009

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