Can an injured worker get workers’ compensation benefits if they fail to fully disclose all of the information about a prior injury in the same part of the body? The New York Court of Appeals said they can’t in a case decided May 12.
A worker with an injured shoulder can’t collect benefits after he told medical providers about a prior shoulder injury but failed to tell them if he received treatment or identify where he may have received medical help.
Didn’t provide all the facts
In the Matter of Nappi v Verizon NY, the employee, a material system technician, filed a claim for workers’ compensation benefits in November 2018 after injuring his right shoulder on Oct. 26, 2018.
When filing the claim, the employee mentioned a prior injury to the same shoulder but didn’t indicate if he’d received treatment and failed to identify any medical providers he may have seen for treatment.
He was awarded benefits from Feb. 4, 2019, to June 15, 2019, after being diagnosed with a rotator cuff tear. He had surgery on the injured shoulder in March 2019.
Carrier has doubts after independent exams
Later, after going through two independent medical examinations, the workers’ compensation insurance carrier argued that benefits weren’t warranted because the employee failed to disclose prior medical treatment to his right shoulder.
A workers’ compensation law judge found there was insufficient evidence to support the carrier’s claims of misconduct. The New York Workers’ Compensation Board modified that decision and found the employee did violate state workers’ compensation laws by failing to provide all the information on his previous injury.
The board rescinded the employee’s workers’ compensation benefits and imposed a penalty of permanent disqualification from receiving wage replacement benefits for this claim.
Evidence supported board decision
On appeal, the employee argued the board erred in finding he violated the law for failing to disclose all the information about his prior injury.
The appeals court found that state law says that a claimant who, in attempting to obtain benefits, “knowingly makes a false statement or representation as to a material fact … shall be disqualified from receiving any compensation directly attributable to such false statement or representation.”
Further, “a fact will be deemed material so long as it is significant or essential to the issue or matter at hand, and an omission of material information may constitute a knowing false statement or misrepresentation.”
Since evidence supported the board’s finding that the employee failed to disclose pertinent information about his prior injury, the appeals court found there was no error in the earlier decision and upheld the board’s decision denying benefits and imposing the penalty.