What do you think: Did the concealment of previous accidents hinder the truck driver’s claim?

West Babylon, NY (WorkersCompensation.com) – A New York employer may be able to avoid a workers’ compensation claim if it can prove that the employee made false statements to obtain benefits. One case shows what it may take to overturn a compensation agency’s decision that the employee did not make false statements.

In this case, a truck driver filed a claim for workers’ compensation benefits, claiming he was injured while loading a truck in April 2021. His leg went through the floor of the truck, injuring his neck, back and wrist.

On his C-3 form, the driver stated that he had previously sustained injuries in the same areas, but could not recall the details. He told the doctor who examined him immediately after the accident that he had been involved in car accidents in the past, but that all of the injuries had resolved with conservative treatment.

The driver also told an independent coroner that he had been involved in an accident in 2017 in which he sustained an upper back injury, but that it healed quickly with physical therapy.

Both doctors asked him about previous accidents in which he had sustained injuries for which he was receiving medical treatment. He did not mention two other accidents in which he was involved – one in 2005 and one in 2018.

The employee was seen on video surveillance at work when he came to supervise a delivery for a day after the accident in 2021.

The carrier objected to the claim on the grounds that the driver had violated Section 114-a of the Workers’ Compensation Act by failing to disclose the previous accidents. The Commission found no violation.

On appeal, the court stated that a plaintiff who knowingly makes a false statement or allegation as to a material fact for the purpose of obtaining workers’ compensation benefits or influencing a decision thereunder should be disqualified from receiving any compensation directly attributable to that false statement or allegation.

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Did the driver’s omissions constitute a misrepresentation of material facts?

A. NOHe did not knowingly make a false statement because he considered – and the Panel accepted this – that the previous accidents were irrelevant.

B. Yes. The fact that he did not return to work until after the accident suggests that he had misrepresented the extent of his injuries.

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If you selected A, you agree with the court in Brown v. Van Liner Ins. Co., No. CV-22-2103 (NY App. Div. 5/30/24), which declined to vacate the panel’s credibility finding.

The court noted that while the exact nature of the previous accidents was “amorphous” at times, the driver disclosed his 2017 accident on Form C-3 and mentioned it to both doctors. Although he did not mention two other accidents, according to the driver, they did not result in relevant, permanent injuries.

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“Plaintiff stated that he did not mention these other two accidents … because he was only asked about previous injuries for which he had received medical treatment and/or whether he had suffered previous injuries at the current injury sites, which was not the case,” the court wrote.

In addition, although the driver went to work one day after his injuries, he only observed and monitored one delivery, as video surveillance confirmed.

The Court upheld the panel’s decision on the grounds that it was not its role to question the panel’s decision on credibility.