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February 28, 2024

Workers' Compensation Board's decision that applicant's misrepresentations in applying for Workers' Compensation benefits warranted disqualification sustained by the Appellate Division

Citing Matter of Koratzanis v U.S. Concrete, Inc., 209 AD3d 1075, the Appellate Division noted "Workers' Compensation Law §114-a (1) provides, in relevant part, that a claimant who, for the purpose of obtaining workers' compensation benefits or influencing any determination relative thereto, 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. Further, noted the court, "Whether a claimant has violated the statute lies within the province of the Board," which is the sole arbiter of witness credibility, and its decision will not be disturbed if supported by substantial evidence.

In the instant matter, although Claimant told the examining physician that he retired in 2014, Claimant testified that he has continued to work in a family flooring business and that he had another job conducting movie audits. Although Claimant testified that he does not have full range of motion with his left knee, which he stated does not bend regularly, surveillance videos did not confirm any physical limitations. 

While Claimant testified that he gave his best efforts during an independent medical examination and that he has "good days and bad days," Claimant's testimony regarding whether he was truthful about his physical condition presented "a credibility issue for the Board to resolve." In the words of the Appellate Division, "[Claimant] was also required throughout the underlying proceedings to provide truthful and accurate information regarding his work activities and side jobs."

The court then found that substantial evidence supported the Board's determination that "[Claimant] violated Workers' Compensation Law §114-a" as well as Claimant's material omissions supported the Board's imposing "a mandatory penalty."

The Appellate Division also sustained the Board's disqualification of Claimant from receiving future wage replacement benefits, noting "the Board is vested with the authority — as an exercise of its discretion — to disqualify a claimant from receiving any future benefits" in addition to imposing the mandatory penalty, i.e., rescinding the workers' compensation benefits already paid a claimant. 

The court opined "The imposition of such discretionary penalty typically is reserved for situations where the underlying deception has been deemed egregious or severe, or there was a lack of mitigating circumstances", citing Matter of Koratzanis v U.S. Concrete, Inc., 209 AD3d at 1077.

Pointing out that "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, thus constituting an abuse of discretion as a matter of law".

In this instance the Appellate Division found "the record supports the Board's finding that [Applicant's] misrepresentations were egregious and severe enough to warrant disqualification" and that the court could not conclude that the penalty imposed by the Board was disproportionate to Claimant's material misrepresentations.

Click HERE to access the Appellate Division's decision posted on the Internet.

 

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