When an employee seeks treatment for a work injury and denies that he or she had a previous injury and misleads the doctor, the Court can find the claim to be fraudulent and dismiss the claim, with prejudice.
This was the outcome in a recent case, Neglia V. Craft Carpentry & Drywall, where the employee filed a Motion for Medical and Temporary Disability Benefits with the NJ Workers’ Compensation Court for an alleged work injury that he said occurred on February 2, 2011. He claimed he tripped on a piece of steel causing him to fall and injure his right knee.
The employer referred the employee for medical treatment. The employee told the doctor that he had never injured his right knee prior to the alleged work incident in February 2011. As a result, the doctor found that the employee required medical care causally related to the alleged work incident.
The employer learned that the employee had a prior right knee injury in the summer of 2010. Accordingly, the employer denied the employee’s request for additional medical treatment on the grounds that the employee knowingly made false statements to obtain compensation benefits.
The employee testified before Judge Tornetta that he had never injured his right knee before the 2011 alleged work incident. Even when confronted with the medical records confirming the 2010 right knee injury, the employee continued to deny the prior injury.
The Workers’ Compensation Judge held that the employee committed fraud pursuant to N.J.S.A. 34:15-57.4(c)(1) and his Motion for Benefits was denied, with prejudice. A Motion for Reconsideration was also filed and denied. The Court concluded that the employee “did not make misstatements concerning his medical history or fail to recall that he had suffered a prior injury to his right knee, he denied that the injury ever occurred.” This denial amounted to fraud in misleading a doctor to find a causal relationship between the alleged work incident of February 2011, and the need for treatment to employee’s right knee.
The employee argued the Court’s holding was contrary to the holding in Bellino v. Verizon Wireless, 435 N.J. Super. (App. Div. 2014). That matter was also litigated and decided by Judge Tornetta. The difference noted by the Court was that the employee in Bellino was found to be credible. She made misstatements regarding treatment 10 years earlier from her work accident. The Court noted that the misstatements had no significance in the various physicians’ determination on treatment and the causal relationship.
In the current case, the Court found the employee’s denial of an earlier knee injury directly resulted in misleading the physician to find the causal relationship. As the misrepresentation was material to the doctor’s findings, the dismissal of the claim regarding the fraud provision of the Compensation Statute was warranted.\
For further information, contact Weber Gallagher Partner Richard Arnold at
rarnold@wglaw.com or 973.242.2706.