If an injured worker withholds information regarding prior injuries in a workers’ compensation case, that worker could face legal backlash for “misrepresenting facts” in court. However, if there’s good reason, that may not be the case.
In Matter of Spinelli v. Cricket Valley Energy Center, a New York appeals court upheld the state’s Workers’ Compensation Board’s decision to award benefits to an injured employee who failed to disclose some previous injuries.
The employee was injured February 2019 when a piece of plywood he was handing to a co-worker fell and struck him in the right shoulder and forearm. He filed a workers’ compensation claim for injuries to his right shoulder, neck and right forearm, as well as a consequential injury to his left shoulder. Benefits were awarded for these injuries.
In May 2020, the employer’s workers’ compensation carrier accused the employee of lying about previous injuries but didn’t provide any proof at that time.
No surgery or physical therapy required
A workers’ compensation law judge ruled against the employee, finding that he did fail to disclose prior injuries. However, the Workers’ Compensation Board reversed because the employee provided a good reason for failing to disclose the information: because those injuries didn’t require surgery or physical therapy and he’d forgotten about them.
The employer appealed, and the appeals court upheld the ruling because the board found the explanation was plausible and the employee credible.
When reporting to doctors about his past medical history, the employee mentioned left knee surgery and a broken right wrist, but he denied having prior issues with his right shoulder, right forearm or neck.
‘They were nothing significant’
When asked in court about a work incident, a home incident and two crashes which caused right shoulder and neck injuries between 2010 and 2016, the employee testified that he didn’t recall those injuries. He explained that even if they required X-rays or CT scans, they were nothing significant and he continued working without any problems.
He explained to the board that he “considered an injury to require damage that results in surgery, physical therapy or some other follow-up treatment, which was not the case with any of the prior injuries.”
The board found this explanation plausible as did the appeals court, so the decision to grant benefits was upheld.