Failing To Disclose Prior Injuries Or Medical Treatment

Workers’ Compensation Law Section 114a(1) may disqualify a claimant from receiving workers’ compensation benefits when he or she knowingly makes a false statement or representation as to a material fact for the purpose of obtaining such benefits.

The “false statement or representation” can come in many forms.  The most blatant involves a claimant who denies, under oath, or in a sworn statement that he or she has not been able to work and it is later determined that that person has in fact been working.

Section 114a fraud allegations can stem from many other types of representations.  In the following case of Martinez v. Lefrak City Management

The Appellate Division, 3rd Judicial Department ruled on 11/08/12 that the claimant had violated Section 114a.

Mr. Martinez was employed as a porter but also worked as a professional boxer.  Medical records showed that on 07/30/04 he was injured in a featherweight boxing match at Mohegan Sun Casino.  In that fight he torn his left bicep.  On 08/09/04 he was informed that he needed surgery to repair it.  9 days later, he reported that he injured his bicep while doing his porter job.  He alleged that he was moving garbage bags at the time.  The Appellate Division affirmed the Workers’ Compensation Board’s ruling that this fact pattern, indeed, violated Section 114a.  The Martinez case seems like an obvious fraud violation but there are many other ways that workers’ compensation carriers can attempt to show fraud violation.

Denying prior treatment on simple questionnaire forms or when giving sworn testimony at a Workers’ Compensation hearing is another common way Section 114a claims begin.  In many instances, injured workers may not recall relatively minor medical care for a similar injury in the past or believe that their prior injury was so minor that it does not require disclosure.  This is a huge mistake.  In fact, we strongly recommend that claimants do not submit signed questionnaire forms directly to the insurance carrier before we have had a chance to review their responses.  Moreover, we caution all claimants to be 100% certain of their responses regarding prior injuries or treatment before they make them under oath.  If someone is not 100% sure that they have never had a prior injury or medical care for a certain body site then they should respond that they do not remember or they are not sure.

Unfortunately, insurance carriers do not care whether or not a statement is intentionally made to deceive the Law Judge.  This means that they will twist the facts, including innocent statements, in an attempt to show that the claimant tried to deceive the employer and Law Judge for the purpose of getting benefits that he or she may not be entitled to.

A single misstatement can means the difference between the claimant receiving proper payment for lost wage benefits or being entirely disqualified from them.