NY Court: Not Every Omission of Prior Injury Constitutes Misrepresentation under § 114-a
A New York appellate court affirmed a determination by the state’s Workers’ Compensation Board that had rescinded that part of a WCLJ’s decision finding that the claimant violated N.Y. Workers’ Comp. Law § 114-a, by failing to disclose prior injuries [Matter of Spinelli v. Cricket Val. Energy Ctr., 2022 N.Y. App. Div. LEXIS 4008 (3d Dept. June 23, 2022)]. Not every omission of a prior injury is cause to find a § 114-a violation. The Court stressed that it was within the province of the Board to find that the claimant’s omission were not material.
Background
In February 2019, claimant was injured when a piece of plywood he was handing to a coworker fell, striking claimant’s right shoulder and forearm. Claimant thereafter established a workers’ compensation claim for injuries to his right shoulder, neck and right forearm, as well as a consequential injury to his left shoulder, and he was awarded benefits. In May 2020, the employer’s workers’ compensation carrier raised the issue of claimant’s violation of Workers’ Compensation Law § 114-a. Following a hearing, the WCLJ found that there had been a violation in that claimant misrepresented material facts by failing to disclose prior injuries. The WCLJ imposed mandatory and discretionary penalties. Upon review, however, the Board rescinded that part of the WCLJ’s decision finding a violation of § 114-a and imposing penalties. The carrier appealed.
Appellate Court Findings
The appellate court noted that claimant reported to doctors treating him for his work-related injury that his past medical history included left knee surgery and a broken right wrist, but that claimant denied having prior pain or problems with his right shoulder, right forearm or neck. At the hearing, when questioned about various right shoulder and neck injuries sustained at work in 2016, in two motor vehicle accidents in 2015 and 2010, and a falling incident at home in 2011, claimant testified that he, for the most part, did not recall such injuries. Even if those injuries involved diagnostic tests being conducted, such as X rays and CT scans, claimant explained that there was “nothing significant” and he continued working without any problems. Claimant explained that he considered an injury to require damage that results in surgery, physical therapy or some other follow-up treatment, which was not the case with any of the prior injuries.
The appellate court concluded that since the Board found claimant’s explanation plausible as to why he had not disclosed the prior injuries, substantial evidence supported the Board’s decision that claimant did not violate N.Y. Workers’ Comp. Law § 114-a, and its decision would not be disturbed.