Did The Employee Make A False Statement?

Many insurers will try to avoid paying out workers’ compensation claims. One way in which they will do so is by trying to prove that the injured employee made false statements in order to obtain benefits. A workers’ compensation board in New York decided that an employee did not make false statements, and an employer tried to argue that they did.

In April 2021, a truck driver filed a claim for workers’ compensation benefits alleging that he was injured while loading a truck. His leg went through the floor of the truck, causing injuries to his back, neck, and wrist. His employer had insurance with Van Liner Insurance Company.

On his C-3 form, the driver said he suffered injuries to those same areas in the past. However, he could not recall the details. He told the doctor that he had been involved in motor vehicle accidents in the past and suffered injuries, but those injuries had been resolved with treatment. The driver also told an independent medical examiner that he was involved in a car accident in 2017. He suffered an upper back injury but it quickly resolved with physical therapy.

The problem is that the doctors did not ask the driver about prior car crashes in which he suffered injuries. Therefore, the driver did not mention the accidents he was involved in in 2005 and 2018.

Following the accident in 2021, video surveillance showed the employee at work for one day to supervise a delivery. This happened the day after the accident. However, the court saw nothing wrong with this, as the man merely observed and oversaw a delivery,

The carrier, Van Liner Insurance Company, opposed the claim on the basis that the driver violated state workers’ compensation by failing to disclose the prior accidents. The board found no violation, as the man did not suffer any lasting injuries to the same body parts. The man was asked only about prior injuries for which he received medical treatment.

On appeal, the court explained that a claimant who knowingly makes a false statement or representation as to a material fact shall be disqualified from receiving any compensation. This was not the case. The driver did not make any false statements, and withholding information is not the same thing. While he did not disclose the nature and injuries of all the accidents he was involved in, that information was immaterial to the claim.

The court declined to reverse the board’s credibility determination. The court stated that it was not its role to second-guess the board’s credibility decision, so it affirmed the board’s ruling.

Contact Us for More Information About Workers’ Compensation Benefits

Workers’ compensation claims can be hard to prove. Withholding information and making false statements are not the same thing.

If you have been involved in a workplace accident, get the help you need from a White Plains workers’ compensation lawyer from The Law Office of Michael Lawrence Varon. Our team will work hard to get you favorable results. To schedule a consultation, call (914) 228-1770 or fill out the online form.

Source:

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