Worker’s Compensation: Who do the courts believe? | New Jersey Workers’ Compensation Fraud

The Workers’ Compensation Act (N.J.S.A. 34:15) is mandatory social legislation that is designed to balance concern over employee rights and health with financial burdens on employers. The act ensures employees will be paid when they are injured on the job and provided medical treatment and therapy until the employee is ‘cured’, regardless of fault.  However, in exchange for the disability benefits and medical treatment, the employee releases rights to pursuing other remedies against the employers. This allows employers to incorporate workers’ compensation insurance costs into their operating cost and avoids prolonged litigation that could leave an employee out of cash for the meantime. Temporary benefits are payable from the first day that an employee misses work as a result of an injury until the first day they can return to work.  Because the benefits of the Act touch so many people courts interpret its privileges liberally.

New Jersey’s workers compensation statute also bars claims for fraudulent  ‘injuries’ and or claims for fraudulent TDB payments.   In order to find someone culpable (guilty) of fraud it must be shown that they acted “purposely or knowingly.” This means that someone knew they had a fraudulent claim but went ahead with it anyway with the intention of cheating the system.

In the recent matter of Bellino v. Verizon Wireless, heard by the New Jersey Appellate Division, Verizon Wireless accused Ms. Bellino of attempting to commit fraud arguing the testimony of the petitioner’s physicians was inconsistent.  Their arguments was based on:

  1. her employer’s authorized treating doctors said she had no injury,
  2. she did not disclose her medication or substance abuse history,
  3. and she failed to disclose past medical problems.

The case was first heard in Workers’ Compensation Court who found Verizon Wireless had not proved fraud by a preponderance of the evidence. The Appellate Division found Verizon Wireless the Judge of Compensation (a) is not bound to any one medical statement but can choose which ones he/she believes to be credible and (b) deference is given to the judge of compensation regarding credibility findings because it is that judge who can observe the witnesses demeanor, and make first hand observations of the lay and expert testimony.

With regard to any attempt to prove workers comp fraud within the confines of the New Jersey workers compensation statute, three facts must be prove by the respondent:

  1. The injured worker acted purposes or knowingly (as explained above).
  2. The worker knew that the “fraudulent” statement they made was material (necessary) to obtaining the benefit.
  3. The intention of the “fraudulent” statement was to intentionally receive an unentitled benefit.

Reiterating the trial court, the appeals court found Verizon Wireless failed to prove any of these. While Ms. Bellino’s statements may not have disclosed everything, the fraud provision was not meant to punish people for not being able to present their entire medical history when there is a real injury, but only for people who seek to defraud the system.

Download the entire case here: Bellino vs Verizon Wireless

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