Credible Misstatements v. Lies in Workers’ Compensation Cases

In the recent case of Neglia v. Craft Carpentry and Drywall the Appellate Division court was asked to reconsider a case in two situations (a) was the trial court’s decision based on an incorrect or irrational basis, and (b) the court failed to consider some very relevant or probative evidence. The case involves a petitioner who was in two separate accidents at work, one in February, 2011 and the other in August, 2010.  At issues is the fact that the petitioner went to a doctor for the 2011 case and why the petitioner did not mention the first injury.  The court ruled this was in an attempt to fraudulently establish a causal relationship between his knee injury and the 2011 incident instead of the 2010 incident. It was seen as especially suspicious that the petitioner did not mention the previous accident because they happened only half a year apart.

The petitioner argued that even if he did sustain an injury from the 2010 incident, because he did not know he was actually injured from that accident then he could not have purposely or knowingly made a false or misleading statement or omission in this case, in order to obtain workers’ compensation benefits. He cited Bellino v. Verizon Wireless, 435 N.J. Super. 85 (App. Div in order to deny benefits based on fraud the employer must show that the injured employee 1) acted purposely or knowingly when he gave false information or omitted important information (like a prior accident), 2) the employee knew that what they were falsely saying or purposely omitting was material, or important to the case, and 3)  the statement or omission was made for the purpose of fraudulently obtaining benefits.  In that particular case the claimant did make mistakes in her presentation of her medical history but the judge determined that the inaccuracies she provided were not intentional. On the other hand in the case this blog discusses, the judge held that the petitioner/claimant was being dishonest. That determination is made by the judge based on the testimony he sees and hears; a ruling from the trial court the appellate court will not disturb.

There were other details involved in this case but the moral of the story is that when claiming workers’ compensation benefits and you are in a doctor’s office at any time for any purpose be honest about your medical history. Even if you have been involved in a prior accident that you do not believe gave you any injuries it is still important to disclose it. If it is true that you were not injured, despite being in a prior accident, then your medical records or a licensed medical professional will likely be able to show that in court. But if the court determines that you are trying to conceal something you are providing your employer with an easy way to discredit what may be a very valid claim.