Summary
The Appellate Division, Third Department, affirmed the Workers' Compensation Board's decision disqualifying a claimant from receiving wage replacement benefits after he violated Workers' Compensation Law § 114-a. Surveillance videos and medical testimony demonstrated that the claimant repeatedly exaggerated his physical limitations and feigned symptoms during independent medical examinations to secure indemnity payments. The court found substantial evidence supported the Board's determination that the claimant's misrepresentations were material and egregious, warranting both mandatory forfeiture of past benefits and a discretionary lifetime bar on future claims.
Topics
Practice areas
Questions Presented
- Whether the Board's imposition of a mandatory penalty disqualifying claimant from wage replacement benefits under Workers' Compensation Law § 114‑a was supported by substantial evidence
- Whether the discretionary lifetime bar penalty is within the Board’s authority and not an abuse of discretion
Holdings
- The Board’s finding that claimant violated § 114‑a and the mandatory penalty disqualifying benefits is supported by substantial evidence; the decision is affirmed.
- The discretionary lifetime bar penalty is within the Board’s authority and does not constitute an abuse of discretion; the penalty is affirmed.
Key quotations
“the Board's findings are supported by the record — that the surveillance videos demonstrate that, over the course of years, claimant's disability "appeared non‑existent" and that he had "no apparent disability," and that his misrepresentations at the IMEs had been egregious and sufficiently severe to warrant disqualification” (*3)
“judicial review of the penalty imposed is limited to whether the penalty constitutes an abuse of discretion as a matter of law and, as such, a penalty must be upheld unless it is so disproportionate to the offense as to be shocking to one's sense of fairness” (*2)
Factual background
Claimant, a maintenance worker, filed two workers' compensation claims for injuries sustained in 2013. Surveillance videos recorded between 2018 and 2021 showed claimant performing heavy labor and walking without a cane, contradicting his statements at independent medical examinations where he claimed severe limitations. The Board concluded claimant knowingly made false statements under Workers' Compensation Law § 114‑a.
Procedural history
The Workers' Compensation Law Judge found claimant had misrepresented his disability at multiple IMEs, imposing a mandatory penalty disqualifying wage replacement benefits. The Board affirmed the finding. Claimant appealed the penalties.