Compensability and Withdrawing Admissions of Liability – Fraud – Respondents Demonstrated that the Claimant Lied about the Details of an Alleged Work Injury To Obtain Benefits

Claimant was a cook for a fast food restaurant.  He reported a work injury on November 28, 2014.  Specifically, the Claimant reported that he was randomly assaulted by several men when taking out the trash.  Due to the fact that Claimant specifically reported he did not know the men involved with the assault, the incident was deemed to be work-related under Colorado law.  The Claimant suffered extensive head and other physical injuries and received a 42% impairment rating.  Respondents ultimately admitted to extensive workers’ compensation benefits in excess of $200,000.  

Claimant subsequently attempted to obtain permanent total disability benefits in 2017.   The claim was referred for litigation for the first time due to Claimant’s allegations that he could never work again due to this work injury.  Mr. Miller handled the claim and recommended further investigation into whether the original reported injury was legitimate (instead of just focusing on whether the request for PTD benefits was legitimate).  

The resulting investigation demonstrated the following facts: (1) video surveillance suggested that Claimant had actually seen the assailants in the restaurant immediately before the assault occurred; (2) the same surveillance demonstrated that Claimant did not take out any trash when he left the store immediately before the assault; (3) Claimant’s extended family member was interviewed and had alleged that the assault occurred due to an unspecified drug deal that had gone wrong; (4) an undisclosed medical record was found from Claimant’s private psychologist which confirmed that claimant knew the men involved with the assault due to a prior drug transaction; (5) the Claimant had strangely reported that the assailants only took about half of the $500 in money he was carrying at the time of the assault; and (6) there were numerous other facts presented which suggested that the assault was related to a personal issue involving drugs.   

The Administrative Law Judge (ALJ) ultimately agreed with Respondents’ arguments and specifically found that the Claimant had engaged in fraud when alleging that he suffered a work injury.  The ALJ allowed Respondents to withdraw the admissions of liability filed on the case and found that a work injury had not occurred.  The ALJ’s Order was based on the fact that the Claimant knew the assailants and the assault was due to a personal issue involving drugs instead of anything related to work.  The ALJ’s Order was subsequently affirmed by both the Industrial Claim Appeals Office and the Court of Appeals of Colorado when the Claimant filed an appeal.  The final Order from the Court of Appeals will allow Respondents to recover from the Claimant all of the workers’ compensation benefits paid on the claim due to the fraud involved.    

Allen Martin v. Jack in the Box d/b/a Qdoba Mexican Grill 19CA0612 (Colo.App. April 9, 2020).  

Would you like to know more? Contact Brad Miller at bmiller@pollartmiller.com or 303-414-0783.

From the June 2020 Newsletter

2020-07-02T09:30:47+00:00