A New York appellate court, in Martinez v. Lefrak City Mngmt., 2012 N.Y. App. Div. LEXIS 7330 (3rd Dept., Nov. 8, 2012), recently affirmed a finding by the state’s Workers’ Compensation Board that ruled a claimant, whose day job was as a porter while he separately pursued a career as a professional boxer, had violated a workers’ compensation fraud statute [Workers’ Compensation Law § 114-a] so as to disqualify him from receiving additional workers’ compensation benefits.
Claimant worked for the employer as a porter. On July 30, 2004, claimant took part in a featherweight boxing match at the Mohegan Sun Casino. Casino records and an August 4, 2004 hospital MRI showed that, in the course of that match, claimant sustained, among other things, a complete tear of claimant’s left bicep. There was additional evidence that on August 9, 2004, claimant was informed that surgery would be necessary to repair it. Nonetheless, claimant returned to his duties as a porter and, on August 18, 2004, reported to the employer that he injured his left arm while moving garbage bags. Claimant was taken to the hospital immediately and, on August 20, 2004, he underwent surgery to have his torn left bicep repaired. Citing the August 18, 2004 injury, claimant then filed for workers’ compensation benefits, whereupon it was ultimately determined that he had a 30% schedule loss of use of his left arm.
Prior to finalization of this award, however, the employer’s carrier raised the issue of whether claimant had filed a false claim for benefits and/or misrepresented the extent of his injury by failing to disclose the prior July 30, 2004 injury to any of the medical providers who examined him following the claimed August 18, 2004 injury. The Board concluded that, while the record sufficiently showed that claimant sustained a work-related accident on August 18, 2004, the proof also supported a finding of a Workers’ Compensation Law § 114-a violation “based on the claimant’s denial of a prior left arm injury to the multiple medical providers and consultants.” Consequently, it was determined that, while claimant would still be entitled to medical benefits, he was disqualified from receiving a schedule loss of use award. Claimant appealed.
The court indicated that while claimant maintained that his left arm was not injured in the July 2004 fight, this created a credibility issue for the Board. The court noted that the record not only contained proof that claimant had been injured in the fight, there was also evidence that claimant’s physician called claimant prior to the August 18, 2004 accident and told him that his left bicep was torn and required surgery. Under these circumstances, the Board’s conclusion that claimant misrepresented his status when he failed to thereafter report the prior injury in his medical history was supported in the record, regardless of the existence of any proof that might have supported a contrary result.