Successful Defense in Established Workers’ Compensation Case Shows Claimant Committed Fraud
Case Study

Successful Defense in Established Workers’ Compensation Case Shows Claimant Committed Fraud

December 19, 2018

Tapped to defend a vocational school and a major insurer against an established workers’ compensation claim, Goldberg Segalla special counsel Andrew R. Arbeit came into some compelling evidence. A private investigation firm’s surveillance of the claimant, who said he had torn tendons in his left shoulder while lifting scaffolding over his head in 2015 and was now alleging the injury was permanent and had caused him to lose the use of his left arm, showed him engaged in a variety of physical activities around his home. There also was a social-media investigation undermining the man’s permanency claim.

Arbeit, a member of our Workers’ Compensation Practice Group, argued that the claimant was not as permanently disabled as he said he was—indeed, that he had lied about the severity of his permanent physical condition to the doctors and the workers’ compensation judge to increase his schedule-loss-of-use award, thereby committing fraud. The judge didn’t agree that the man had lied or committed fraud, but we appealed his decision and, on October 31, 2018, the workers’ compensation board reversed it, finding that the claimant had committed fraud and that both mandatory and discretionary penalties were applicable.

The decision, which the claimant did not appeal, likely saved our clients between $51,370 and $76,330 in future awards and also gave them a $32,900 overpayment credit that they could seek, if they so choose, in a civil suit against the claimant.