Was Nurse’s Injury After Patient Fell on her a Load of CRPS?

What Do You Think?

An employee who makes herself look more injured than she is may find herself without benefits in New York. A case involving a worker for a dialysis center highlights what types of behavior might bar compensation benefits based on fraud or misrepresentation.

In 2014, claimant, a registered nurse, was injured at work when a patient fell on her. She obtained workers' compensation benefits for complex regional pain syndrome (CRPS) involving her right foot, left leg, and both upper extremities.

In separate visits, two doctors judged her to be extremely limited in terms of her ability to function physically, because of the condition. The claimant reported that her ability to work, sit, or stand for extended periods, grasp objects or lift overhead, walk or run or engage in recreational activities, were all significantly affected and diminished by her CRPS in the upper and lower extremities and neck.

After they saw surveillance video of the claimant engaging in regular activities, such as holding a bag of recyclables at shoulder hight and walking without an expression of pain or discomfort, they believed claimant had misrepresented or exaggerated her disability and limitations when she was examined. She did not look like the same patient in the videos.

In New York, claimant who, for the purpose of obtaining workers' compensation benefits or influencing any determination relative thereto, knowingly makes a false statement or representation as to a material fact shall be disqualified from receiving any compensation directly attributable to such false statement or representation. Workers' Compensation Law § 114-a(1).

Did the claimant’s actions fall under § 114-a(1)?

A. Yes. The contrast between her appearance at doctor’s visits and her appearance in the videos indicated she misrepresented her condition to the doctors to obtain benefits.

B. No. She could have been just having a good day physically when the videos were taken.

If you selected A, you agreed with the court in Carpenter v. Albany Dialysis Center, No. CV-23-1587 (N.Y. Sup. Ct. App. 02/06/25), which held that the employee was not entitled to benefits for her CRPS.

The court noted that the two doctors changed their minds after reviewing the videos and concluded that the claimant had exaggerated her symptoms and limitations and during her appointments. That made sense, given that the videos purportedly showed the claimant engaging in everyday activities, such as lifting a bag of recyclables and holding it at shoulder level, without any apparent difficulty.

“[C]laimant is seen walking without any evidence of pain or discomfort exhibited in her face, able to walk for extended periods of time in sneakers without assistive devices or any altered gait,” the court wrote.

The Board was free to reject the claimant’s “self-serving explanations,” the court wrote. The evidence showed that she was less than forthcoming to the doctors about her condition and abilities. The court affirmed the Board’s determination that she misrepresented her condition for the purpose of obtaining benefits.

The court also upheld the board’s penalty against the claimant of permanent disqualification from future wage replacement.

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