ICAP recently affirmed an ALJ’s Order finding Claimant committed fraud in prior hearing to obtain benefits, reversing prior order, and dismissing claim with prejudice.
Claimant testified at the first hearing before the ALJ that she had a pre-existing condition but had been pain free without the need for medical treatment for an extended period of time prior to the alleged work injury. The ALJ credited this testimony in finding the claim compensable because Claimant sustained an aggravation of a pre-existing condition. This Order was not appealed and became final. Subsequently, Respondents located medical records documenting that Claimant was seen by another provider for similar pain complaints only two days prior to the alleged work injury and had been consistently treating for the same condition on an ongoing basis. This directly contradicted Claimant’s testimony that she had been pain free without the need for medical treatment for an extended period of time. By this time, a DIME had taken place on the claim. Respondents filed an Application for Hearing to overcome the DIME and reopen the prior Order finding the injury compensable on the basis of fraud. At the subsequent hearing, the ALJ found that Claimant had committed fraud and fraudulently induced the court to award her benefits. The ALJ reopened the prior order on the ground of fraud and found Claimant did not sustain a compensable injury. Claimant’s claim was dismissed with prejudice. This Order was recently affirmed by ICAP and remanded for a second hearing to determine if Claimant must repay Respondents for the medical benefits and temporary disability benefits she received. Jones v. Regis Corperation W.C. No. 4-976-657 (ICAO August 18, 2017)