Failure to Disclose Prior Work-Related Injuries Proves Fatal for NY Worker’s Claim for Continued Benefits

A New York appellate court affirmed a decision by the state’s Workers’ Compensation Board that found an injured worker’s failure to disclose work-related injuries he sustained in 1998 and 2002, for which he received schedule loss of use awards, was the sort of misrepresentation prohibited by N.Y. Workers’ Comp. Law § 114-a and that based on that misrepresentation, the worker should retroactively be barred from receiving workers’ compensation wage replacement benefits and further, should be prospectively disqualified from receiving future benefits [Matter of Ali v. New York City Dept. of Corr., 2022 N.Y. App. Div. LEXIS 3224 (3d Dept. May 19, 2022)]. The court was not persuaded by the worker’s arguments that, among other things, his prior claims did not need to be disclosed because they were “in the system.”

Background

Claimant, a correction officer, filed two C-3 forms alleging that he sustained work-related injuries after being assaulted by an incarcerated individual. On the C-3 completed by claimant, claimant alleged that he sustained injuries to his head, neck, face and back and affirmatively denied any prior injuries to those body parts. Ultimately, the claim was established for post-traumatic stress and injuries to claimant’s head, neck, face, back, both hands, both shoulders and both hips.

Following independent medical examinations and the depositions of various providers, the employer and its workers’ compensation carrier raised the issue of a N.Y. Workers’ Comp. Law § 114-a violation based upon claimant’s failure to disclose work-related injuries that he sustained in 1998 and 2002, for which he received schedule loss of use awards. A WCLJ subsequently ruled that claimant violated § 114-a, disqualified claimant from receiving wage replacement benefits from July 31, 2014 to May 20, 2020, and imposed a discretionary penalty permanently disqualifying claimant from receiving future wage replacement benefits. The Board affirmed and Claimant appealed.

Appellate Court Decision

The appellate court said there was no question that claimant consistently failed to disclose the work-related accidents that occurred in 1998 and 2002, which resulted in injuries to, among other sites, his right arm and for which he received schedule loss of use awards. No mention of these accidents was made on either of the C-3 forms filed in this matter, and, although claimant did disclose—in the context of his past medical history—the injuries that he sustained during two incidents that occurred in 2011, he failed to advise any of the treating or evaluating physicians of the injuries that he suffered in either 1998 or 2002.

When asked why he did not disclose the 1998 and 2002 injuries or awards to any of the relevant physicians, claimant testified that he thought those accidents were old and/or occurred too long ago to be considered important. Claimant further testified that he did not think that he needed to mention the prior injuries or awards because they were already in the workers’ compensation system.

The appellate court stressed that the Commission was free to reject claimant’s self-serving explanations. The court added that in light of claimant’s admitted failure to disclose the 1998 and 2002 incidents and resulting injuries, substantial evidence supports the Board’s finding that claimant’s misrepresentations and/or omissions constituted a violation of N.Y. Workers’ Comp. Law § 114-a. Rescission of the benefits previously awarded was, therefore, proper.

As to the discretionary penalty imposed, the court added that it was well settled that judicial review was limited to whether the penalty constituted an abuse of discretion as a matter of law and, as such, a penalty must be upheld unless it was so disproportionate to the offense as to be shocking to one’s sense of fairness, thus constituting an abuse of discretion as a matter of law. The appellate court held that the record supported the Board’s finding. Accordingly, it would not disturb the Board’s decision.