WINNING RESULTS: LOIS Proves Fraud, Counters Claimant’s Implausible Arguments

Lois Law Firm Associate Scott A. Grossman obtained a WCL Section 114-a violation victory in a New York Workers’ Compensation case. The claim was accepted for a left knee injury due to a slip-and-fall at work. In preparing the matter for litigation, LOIS Paralegal Brenna O'Brien and Attorney Grossman obtain court documents for a 2019 motor vehicle accident, including a Verified Bill of Particulars and Verified Supplemental Bill of Particulars. The lawsuit indicated that the Claimant sustained a left knee injury as a result of that incident. MRI reports for the left knee related to that suit revealed a meniscus tear, as well as other findings. Indeed, the Claimant’s left knee MRI from the 2019 accident had virtually identical findings compared to the MRI taken as a result of the 2024 work-related incident. Attorney Grossman raised a fraud defense, and the matter was set for trial.

The Claimant denied sustaining a left knee injury in the motor vehicle accident during the trial, explaining that he had a right knee injury due to the 2019 car accident that needed surgery. Grossman confronted the Claimant with his Bills of Particulars and the MRI reports, and the Claimant then changed his story to not remembering his left knee was hurt. He acknowledged signing the sworn-to lawsuit documents, missing a significant time from work after the prior motor vehicle accident, and having a prior MRI for his left knee. The Claimant’s counsel argued that his client forgot about the left knee injury and that personal injury attorneys generally “throw everything into a Bill of Particulars.” Grossman countered that this was not a standard practice and that there were serious implications in the Claimant’s counsel’s assertions, relying on his experience in general liability.

Ultimately, the Law Judge decided he wanted to review the record and would issue a Reserved Decision. The Reserved Decision imposed a mandatory penalty pursuant to WCL Section 114-a, as well as a discretionary penalty. The decision noted that it was concluded that the Claimant’s omission of a previous injury to the injured area for which compensation was sought and eventually paid was not only significant but also material and knowingly made. As a result, the indemnity benefits related to the case were severed.