Failure to report subsequent injury doesn't amount to fraud

The panel found there was insufficient evidence to establish that the employee knowingly made false statements or representations for the purpose of influencing his workers' compensation claim.

Case name: Evergreen Cemetery, 110 NYWCLR 85 (N.Y.W.C.B. Panel 2010).

Ruling: A New York Workers' Compensation Board panel held there was insufficient evidence to support a finding that the claimant knowingly made false statements or representations for the purpose of influencing his workers' compensation claim.

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What it means: The fact that the claimant did not report a subsequent motor vehicle accident at a hearing and was evasive about his back being injured in the subsequent accident is not necessarily determinative of whether he made false representations in violation of WCL Section 114-a, especially where he was not sworn in, did not give testimony, and was not asked any questions.

Summary: The employee injured his back, thumb, wrist and shoulder in a work-related accident. Several years later, he was hit as a pedestrian and suffered multiple injuries, including memory loss. The employer/carrier sought to terminate the employee's workers' compensation benefits because he failed to mention the pedestrian accident during a hearing. The panel found there was insufficient evidence to establish that the employee knowingly made false statements or representations for the purpose of influencing his workers' compensation claim. The fact that he did not report the accident or admit that he injured his back was not determinative, as he was not sworn in, did not give testimony, and was not asked any questions. Further, he was confused about certain details because of his memory loss.

Read more at the WorkersComp Forum homepage.

August 2, 2010

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