What Do You Think: Did Not Mentioning Prior Accidents Put Brakes on Truck Driver’s Claim?

West Babylon, NY (WorkersCompensation.com) – An employer in New York may be able to avoid a workers’ compensation claim if it can establish that the employee made false statements in order to obtain benefits. One case indicates what it might take to overcome a workers’ compensation board’s decision that the employee did not make false statements.

In that case, a truck driver filed a claim for workers' compensation benefits alleging that he was injured in April 2021 while loading a truck. His leg went through the floor of the truck, injuring his neck, back, and wrist.

On his C-3 form, the driver said he received prior injuries to the same areas, but he could not recall the details. He told the doctor who examined him right after the accident that he had been involved in vehicular accidents in the past but that all the injuries had resolved with conservative treatment. 

The driver also told an independent medical examiner that he was involved in a 2017 accident resulting in an upper back injury that quickly resolved with physical therapy. 

Both doctors asked him about prior accidents resulting in injuries for which he received medical treatment. He didn’t mention two other accidents he was involved in–one in 2005 and one in 2018.

Video surveillance showed the employee at work when, following the 2021 accident, he went in for one day to supervise a delivery.

The carrier opposed the claim on the basis that the driver violated Workers' Compensation Law § 114-a by failing to disclose the prior accidents. The board found no violation.

On appeal, the court explained that a 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.

Did the driver’s omissions amount to a false statement of material fact?

A. No. He didn’t knowingly make a false statement, given his belief, which the board accepted, that the prior accidents were irrelevant.

B. Yes. The fact that he went into work after the accident indicated he was misrepresenting the extent of his injuries.

If you selected A, you agreed with the court in Brown v. Van Liner Ins. Co., No. CV-22-2103 (N.Y. App. Div. 05/30/24), which declined to reverse the board’s credibility determination.

The court pointed out that though the exact nature of the prior accidents was “amorphous” at times, the driver disclosed his 2017 accident on the C-3 form and mentioned it to both doctors. While he failed to mention two other accidents, those accidents did not result in pertinent, lasting injuries, according to the driver.

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“Claimant explained that he did not mention these other two accidents … because he was asked only about prior injuries for which he received medical treatment and/or whether he had sustained prior injuries to the current sites of injury, which he had not,” the court wrote.

Further, while the driver went to work one day after the injuries, he merely observed and oversaw a delivery, as confirmed by the video surveillance.

Stating that it was not its role to second-guess the board’s credibility decision, the court affirmed the board’s ruling.

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