Claimant, an outdoor technician, suffered work related injuries to both of his knees. The case was established by the Workers’ Compensation Board and the claimant was collecting weekly benefits while not working for the employer. Although there was no dispute over the claimant’s work related injuries, the insurance carrier raised the issue of fraud. The carrier alleged that the claimant was working in another capacity while he was out of work. The insurance company obtained videotape surveillance of the claimant performing activities, which they claimed were inconsistent with the degree of disability he allegedly suffered. The carrier also alleged that the claimant filled out a questionnaire at an appointment with the insurance company doctor (IME) stating the following: the claimant was only able to walk one block, could only stand for one hour, was not working and unable to drive.
The videotaped evidence was viewed during trial showing the claimant working as a volunteer youth athletic coach, walking more than the equivalent of one block, standing for more than one hour and driving a vehicle. The carrier also produced evidence that the claimant maintained and promoted a separate business through the internet. The Workers’ Compensation Board Panel determined that the claimant knowingly made false statements and representations of material fact for the purpose of obtaining compensation benefits and entered a finding that he committed fraud. As a result, the claimant is barred from obtaining monetary compensation for his injury.
Claimants must be very careful if they are out of work and claiming weekly benefits. The insurance company will closely review Workers’ Compensation forms, doctor’s reports and your activities. Even if you are not getting paid while doing an activity, you must report that activity. The insurance companies have become very aggressive in pursuing claims of fraud. If you suffered an injury you should speak with us about what you can and cannot do while seeking Workers’ Compensation benefits.
–Written/Submitted by FOA Attorney Robert Seidner, Esq.
