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Failure to disclose accident leads to loss of comp benefits


An appeals court in New York on Thursday affirmed an injured HVAC technician’s loss of indemnity benefits after he failed to disclose a car accident following his workplace injury.

The worker suffered an injury to his right hand while preparing equipment for repair and his workers comp claim was established for hand injuries and complex regional pain syndrome, along with exacerbation of anxiety and depression, according to documents in 2021 NY Slip Op 05374, filed in the Appellate Division of the Supreme Court of New York, Third Department in Albany.

Months after his injury an independent medical examiner asked the man’s wife to fill out an intake questionnaire regarding his injuries and medical history, which the man then signed.

In response to a question asking if the claimant “had any subsequent injuries or accidents” after the work incident, the claimant's wife answered, "back pain.” The employer later learned that he had been involved in a roll-over motor vehicle accident one month after the workplace incident and had been hospitalized overnight.

The emergency department admissions assessment noted that the claimant had a right arm abrasion, among other injuries. Subsequently, the employer and its insurer alleged that the claimant violated workers comp law “by failing to, among other things, disclose … that he was involved in a motor vehicle accident,” documents state.

The Workers' Compensation Law Judge agreed and imposed penalties of a reduction in ongoing indemnity benefits of $400 per week for 26 weeks. On appeal, the Workers' Compensation Board increased the mandatory penalty of disqualification from indemnity benefits for five years, “finding claimant's conduct sufficiently egregious” that it also permanently disqualified him from receiving future income benefits.

In affirming, the appeals court wrote that it agreed with the board that the “claimant's failure to disclose the motor vehicle accident … was so egregious that a permanent disqualification was warranted.”