Recent NY Decision Helps Employers Fight Fraud

On April 21, 2011, a court decision, “Poli v. Taconic Correction Facility”, was published which, if acted upon, carries vast potential for reducing fraudulent and exaggerated comp claims.

 

 

The worker had a back injury, not related to work, in 2006. In October 2007, he had a work related back injury. However, the reports filed by the treating doctor made no mention of the prior injury. Nor was it reported to the carrier’s medical expert. (WCxKit)

 

 

Eventually, the WCB and the higher court cut off the worker from future wage loss payments for the injury, a decision which could save the employer hundreds of thousands of dollars in reserves.

 

 

The section of the compensation law, WCL Sect 114-a, has been law for years. Similar decisions have been made from time to time, but carriers and employers do not make it a practice to search for concealed prior injuries; instead, these are usually discovered by accident – a search technique with a predictably low chance of success.

 

 

Routine searching for priors on many classes of questionable claims, or those with a high probability of prior injury, can reduce permanent partial disability settlements to a fraction of what is currently being paid. A search does not have to show concealment or evil intent; many innocent lapses, if discovered, afford opportunities for apportionment or settlement at a substantially reduced rate.

 

 

This writer has recently seen vigorous investigations produce reductions of settlement by 85%, where there were a number of prior claims, easily discovered but ignored by most claims units. (WCxKit)

 

 

The employer must become involved, but needn’t be an investigator. Nearly all employers have, in a personnel file, the information needed for a cost reduction expert to obtain evidence of prior unrelated injury. However, the employer must take an active role in requesting that such searches be done. A claim which has a dubious history, is unwitnessed, or occurs to an older worker or one with a history of significant absences cries out for further inquiry. 

 

 

 Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, New York. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans, and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.