Compensability—a claimant’s attempt to create a false medical record is not sufficient to overcome his own prior statements

Claimant was an insulation installer who alleged he injured his back on two separate occasions while working for the employer.  He claimed the initial incident occurred while he was jumping in and out of a vehicle to clean the windshield in a snow storm due to malfunctioning windshield wipers.  The second incident occurred while he was allegedly loading a ladder. Claimant did not immediately report either incident to his employer and testified that he was unable to report it because neither of his two supervisors was responding to his text messages nor answering their phones.  He also told one of his supervisors that he was going to the hospital for back pain but denied a work-related injury. One month after the alleged incident, claimant reported the “injury” to the general manager and was referred to an authorized treating physician (ATP). Claimant reported the wiper and ladder incidents to the ATP who opined that in the absence of any other explanation, claimant’s injury should be considered work-related and recommended various treatment.  Claimant asserted that the ATP’s records and causation opinion supported his testimony and a work-related injury. The Administrative Law Judge (ALJ) found claimant’s initial failure to report an injury as well as his denial of a work-related cause was more credible than his subsequent reports to the ATP and concluded that the ATP’s opinion was based on inaccurate information. The claim was denied and dismissed.  

 Cesar Martinez-Villalobos v. Truteam & Ace American Insurance, W.C. 5-104-509 (January 10, 2019)

Would you like to know more?  Contact Michelle Prince at or 877-259-5693.


From the February 2020 Newsletter