NY Claimant's False Representations Lead to Disqualification from Future Benefits
A New York appellate court affirmed a determination by a state Workers’ Compensation Law Judge, later upheld by New York’s Board, that disqualified a claimant from receiving future wage replacement benefits after the WCLJ found that the claimant had violated N.Y. Workers’ Comp. Law § 114-a [Matter of Teabout v. Albany County Sheriff’s Dept., 2020 N.Y. App. Div. LEXIS 2305 (3d Dept. Apr. 9, 2020)]. The Board found that claimant made a false statement of fact about her work activities and that she failed to disclose critical information to an examining physician. The appellate court indicated its review of the record confirmed those findings.
Background
Claimant sustained a work-related injury to her foot in 1997, and her claim for workers’ compensation benefits was established. The claim was subsequently amended twice to include other injuries. The self-insured employer thereafter raised the issue of whether claimant violated § 114-a and, following a hearing, a WCLJ found that claimant violated the statute. A panel of the Board upheld the WCLJ’s determination and the claimant appealed.
Appellate Court Decision
As to claimant’s work activities, the Court observed that claimant testified at a 2015 hearing that she had not worked in any capacity or run any businesses since her classification with a permanent total disability, At the 2016 disqualification hearing, however, claimant acknowledged that she operated a photography business and took photographs for parties and family events. Claimant was paid in cash for taking photographs and, in turn she pad her employees in cash. Other evidence disclosed that claimant operated the business under a “DBA,” and that she paid income tax for the photography business.
The appellate court added that claimant’s physician testified claimant had denied any psychiatric history prior to her work accident, as well as any family psychiatric history. Based on those denials, the physician diagnosed claimant with an adjustment disorder with a depressed mood that was causally related to her 1997 injuries. The physician further testified, however, that he subsequently received medical records that revealed “a very full plate of psychiatric issues and stressors that had nothing to do with the [1997] work accident.” As a consequence of that information, the physician apportioned 50 percent of the adjustment disorder to claimant’s personal stressors and 50 percent to the 1997 injury. The physician further explained that his opinion changed because claimant was not entirely forthcoming.
The Court concluded that substantial evidence supported the Board’s determination that claimant violated N.Y. Workers’ Comp. Law § 114-a. The court also found that the claimant’s challenge to the imposed penalty was without merit.