The claimant sustained a work related injury to his neck and back. The respondents admitted liability and filed a General Admission of Liability admitting to temporary total disability benefits (TTD benefits). The claimant reported to his authorized treating provider (ATP) that he could not work, and based on this representation, the ATP restricted the claimant from all work. The respondents continued paying TTD benefits because the ATP restricted the claimant from all work.
Despite telling his ATP that he could not work, the claimant underwent a DOT physical with a different provider and did not report any issues with his neck or back. The claimant reached MMI with no restrictions and the respondents filed a Final Admission of Liability. Subsequently, the respondents sought to reopen the claim based on fraud and sought repayment of the TTD benefits paid as a result of the fraud.
The ALJ found that the claimant made a false representation to the ATP and the ATP relied on the false representations when restricting him to no work. The ALJ inferred that the claimant knew the representations were false and would result in continued TTD payments. The ALJ also found that the respondents relied upon the ATP and continued to pay TTD benefits resulting in damages. The claim was reopened and the claimant was ordered to repay the amount of TTD benefits received as a result of the misrepresentations.
Rolando v. Redi Servs., W.C. No. 5-110-270 (July 13, 2022).