October 16, 2018

Surveillance video and hearing testimony obviates earlier determination that workers' compensation benefit claimant suffered a "permanent total disability"


Surveillance video and hearing testimony obviates earlier determination that workers' compensation benefit claimant suffered a "permanent total disability"
Santangelo v Seaford U.F.S.D., 2018 NY Slip Op 06838,

Workers' Compensation Law §114-a, "Disqualification  for  false  representation," provides for the disqualification of a claimant from receiving future wage replacement benefits pursuant to §15 of said law if he or she is found to have made any "false representation" with respect to his or her claim for benefits.

In 2007, Lawrence Santangelo [Claimant] sustained a work-related injury to his "back and right leg" and underwent surgery. Claimant, however, continued to complain of chronic back pain and reported that he experienced numbness and weakness in his "left leg," which necessitated that he walk with the use of a cane or knee brace. The Workers' Compensation Board ultimately classified Claimant as having a "permanent total disability."

In 2016, the Claimant's former employer's workers' compensation carrier reopened the case, raising the issue of whether Claimant violated WCL §114-a.

Claimant's medical records indicated that "he was in constant pain, required use of a cane or knee brace on a daily basis and was severely impacted in his ability to stand and walk — at times grabbing the wall for stability."

However, surveillance videos of Claimant between August 2015 and March 2016 showed Claimant "walking without a limp, standing and driving for extended periods of time, bending over to do repair work under the hood of a vehicle, and lifting items, such as a car battery, a floor jack and an automobile tire, from the bed of his truck."

In addition, "the only time during the surveillance period that Claimant was observed using a cane or knee brace was during a medical appointment" although later that same day Claimant was observed "walking normally without any assistive device."

The carrier's medical expert testified that Claimant's unrestricted movements and activities depicted on the surveillance videos were inconsistent with complaints of pain and reported limitations expressed by Claimant during the examinations.

After reviewing surveillance video and hearing testimony, a Workers' Compensation Law Judge [WCLJ] ruled that Claimant had violated WCL §114-a and disqualified him from receiving future benefit payments. The Workers' Compensation Board affirmed the WCLJ's decision and denied Claimant's subsequent request for full Board review and, or, reconsideration. Claimant appealed both decisions.

The Appellate Division sustained the Board's decisions, finding that Claimant made false representations regarding material facts and that the Board's ruling was supported by substantial evidence.

The court also rejected Claimant's argument that the Board's decision sustaining the WCLJ's ruling was inconsistent with its 2009 decision, noting  "that the 2009 decision was superseded by a 2012 decision and, in any event, is irrelevant to the issue as to whether [C]laimant subsequently violated WCL §114-a."

The decision is posted on the Internet at:

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