Nathan J. Milner, partner in Goldberg Segalla’s Workers’ Compensation group, provides in CLM Magazine an analysis of fraudulent workers’ comp claims and offers best investigation and litigation practices.

Nate discusses WCL 114-a, noting how it gives authority to New York Workers’ Compensation Board to disqualify lost-time benefits if for the purpose of obtaining compensation pursuant to section 15 of this chapter — or for the purpose of influencing any determination regarding any such payment — a claimant knowingly makes a false statement or representation as to a material fact.

Nate states that “an omission of a relevant fact, or an exaggeration of symptoms to a physician who is determining the claimant’s degree of disability, such as an independent medical examiner,” is what a misrepresentation of facts can be based upon.

Proof, in the form of video surveillance or social media activity of the claimant, is essential in litigating fraudulent workers’ compensation claims.

Nate writes that the “the upside of using video surveillance is that the time period can be definitively asserted by the investigator who conducted the surveillance,” but once it is disclosed, it is difficult to attain more video.

As for social media, he explains the “issues that often arise with the use of social media are authentication and dating the source material.”

Nate explains further that knowing when not to raise a 114-a claim is also important and that before initiating litigation, you must ask if a given situation is a questionable claimant or a generous doctor.

“The best results are obtained when the carrier/TPA, investigator, employer, and defense counsel are all in sync and coordinate together how to proceed and approach a 114-a claim.”

READ THE FULL ARTICLE:

“N.Y. Workers’ Comp: Proving Fraud,” CLM Magazine, September 18, 2023

MORE ABOUT GOLDBERG SEGALLA’S NATHAN J. MILNER:

Nathan J. Milner devotes his practice to defending diverse workers’ compensation claims. He has experience handing hearings before the New York State Workers’ Compensation Board, drafting memoranda, performing legal research, and conducting depositions of medical and other experts. Nate’s background includes working as an assistant supervising hearing attorney with New York State’s Special Funds Conservation Committee, where he handled cases out of its Buffalo, Syracuse, and Albany offices.