Controverting a claim based on an alleged false statement or representation by the claimant in his or her application for workers' compensation benefits
2017 NY Slip Op 06490, Appellate Division, Third Department
A school district employee [Claimant] sustained work-related injuries that caused him to eventually stop working and filed a claim for workers' compensation benefits. He was subsequently classified as having a permanent total disability and was awarded benefits accordingly.*
School district and its workers' compensation carrier [Carrier] subsequently "controverted the claim" alleging that Claimant violated of Workers' Compensation Law §114-a** based upon video surveillance footage allegedly showing Claimant performing activities that Carrier contended demonstrated Claimant's ability to work. A Workers' Compensation Law Judge ultimately ruled that there was no violation of Workers' Compensation Law §114-a. which ruling was affirmed by the Workers' Compensation Board. Carrier appealed the Board's decision.
Workers' Compensation Law §114-a (1) provides that a claimant who "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."
Citing Cirrincione v Scissors Wizard, 145 AD3d 1325, the Appellate Division said that Board "is the sole arbiter of witness credibility, and its determination as to whether a claimant violated Workers' Compensation Law §114-a will not be disturbed if supported by substantial evidence."
Carrier had submitted video surveillance footage showing Claimant's activities at sporting events involving an amateur football team that was organized by Claimant's wife and another individual. Claimant was videotaped walking around the concessions and merchandise areas, helping to move a popcorn machine on one occasion and assisting his disabled daughter take money at the secondary admission gate on another occasion.
Claimant's wife testified that the team was a nonprofit organization and that the money collected through admission, merchandise and concessions was used to cover fixed expenses such as liability insurance and the field rental. She stated that the team relied on the efforts of volunteers and that Claimant did not have specific duties, but was present at the games to support the team. Claimant also testified that he attended the games to support the team and did not work, although he acknowledged that he had assisted his disabled daughter collect money at the back gate.
The Appellate Division said considering this testimony the Board could reasonably conclude that Claimant's activities were minimal and not inconsistent with the representations that he made on the questionnaires provided to the carrier.
Holding that substantial evidence supported the Board's finding that Claimant did not violate Workers' Compensation Law §114-a, the Appellate Division declined to disturb the Board's decision.
* The Workers' Compensation Board subsequently modified this decision and ruled that Claimant sustained a permanent total industrial disability.
** § 114-a of the Workers' Compensation Law provides for the "Disqualification for false representation" as follows: "1. If for the purpose of obtaining compensation pursuant to section fifteen of this chapter, or for the purpose of influencing any determination regarding any such payment, a claimant knowingly makes a false statement or representation as to a material fact, such person shall be disqualified from receiving any compensation directly attributable to such false statement or representation. In addition, as determined by the board, the claimant shall be subject to a disqualification or an additional penalty up to the foregoing amount directly attributable to the false statement or representation. Any penalty monies shall be paid into the state treasury."
The decision is posted on the Internet at: