The Throne of Lies . . . Board Strikes Agreement Based on Fraud

We’re back from our winter hibernation and have a fiery decision from the Superior Court to help kick start the warmer months ahead. Where there is smoke, there is fire. And here, the Board and Superior Court found there was significant smoke and heat coming from the claimant’s pants based on his web of lies.

In Mendoza v. Talarico Building Services, Inc., Claimant sought compensability of his cervical surgery which he argued was the result of a slip and fall at work in July 2018. However, failure to disclose his significant medical history and denial of prior/subsequent incidents to his treating surgeon, Employer’s doctor, and the Industrial Accident Board rendered Claimant incredulous and Claimant’s doctor unreliable. Accordingly, the Board denied Claimant’s Petition for Additional Compensation Due.

Further, the Board granted Employer’s Termination Petition to set aside the parties’ original agreement for workers’ compensation benefits upon a finding that Claimant engaged in fraud in pursuit of benefits. The Board described Claimant’s conduct as blatant lies and blatant omissions, evasive in his communications, and dishonest.

]T]he one universal truth seems to be that Claimant was intent on not providing the details of his ongoing cervical condition to anyone. He continued this pattern of omission and explicit deceit in his specific reports to the insurance adjuster in this matter.

Claimant appealed the Board’s Decision to the Superior Court, arguing (1) the Board erred in finding Employer's expert more credible; and (2) the Board failed to properly consider the elements of reliance and damages in finding fraud.

First, the Superior Cour found that there was substantial evidence to support the Board’s finding that Employer’s doctor was more credible than Claimant’s doctor. The record reflected that Employer’s doctor was more informed on Claimant’s extensive history of injuries and medical records than Claimant’s doctor when forming his medical opinion.

Second, with respect to the Board’s finding of fraud, the Superior Court found there was justifiable reliance on Claimant’s misrepresentation, explaining “Employer relied on material misrepresentations that led Employer to both hire Claimant and enter into an initial agreement with him. Employer presented evidence that it would not have hired Claimant if he had been truthful about his medical conditions, nor would it have accepted Claimant's workers’ compensation claim had it been informed about his medical history and prior diagnoses.”

Then, the Superior Court found that the Board did consider that Employer suffered damages as a result of its reliance on the misrepresentation because the Board credits Employer for all monies expended on benefits to Claimant based on the prior agreement.

Further, the Superior Court determined that even in the absence of fraud, Rule 60(b) provides relief due to misrepresentation or other misconduct of an adverse party. The Court held that “the record is replete with findings from the Board that Claimant made material misrepresentations regarding Claimant's past medical history, with his own treating physicians, including Dr. Zaslavsky, as well as the Human Resources Administrator, the Senior Claims Specialist Adjuster, and Dr. Gelman.”

We hope you all have a wonderful Passover and Easter! And, we hope to bring you more posts soon as we prepare for the Workers’ Compensation Seminar in May! Don’t forget to register.

Best,

Caroline Kaminski