Compensability and Withdrawing Admissions of Liability – Fraud – Respondents Proved that the Claimant Misrepresented Her Medical History and Reported Mechanism of Injury To Obtain Benefits

Claimant was a food preparation specialist for an airline.  She reported a work injury on September 5, 2016.  Specifically, the Claimant reported that the injury occurred when a wheel fell off a cart and she injured her shoulder trying to catch the cart from falling.   The claim was ultimately accepted and Claimant proceeded to have a shoulder surgery.  Claimant was ultimately brought to MMI in February of 2018 with Respondents admitting to and paying over $70,000 in workers’ compensation benefits.  

Claimant subsequently attempted to reopen her claim in 2019.  She alleged that her shoulder condition had worsened and she required a reverse total shoulder replacement.  The treating physicians supported reopening of her claim and need for the surgery.   The claim was referred for litigation for the first time due to the request for the shoulder replacement surgery.

Mr. Miller handled the claim and recommended further investigation into whether the original reported injury was legitimate (instead of just focusing on whether the requested surgery was reasonable and necessary).  The resulting investigation demonstrated that Claimant had prior shoulder problems before the alleged work injury and that there were significant concerns about the reporting of the injury.  At the hearing, claimant’s testimony lacked credibility as she mispresented her prior medical history.  There also was evidence presented that she had not immediately reported the alleged injury to either the Employer or her medical providers.  Most importantly, her story about how the injury specifically occurred was directly inconsistent with the testimony of a fact witness she presented at the hearing. 

The Administrative Law Judge (ALJ) ultimately agreed with Respondents’ arguments and specifically found that the Claimant had engaged in fraud when alleging that she 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 would allow respondents to recover from the Claimant all of the workers’ compensation benefits paid on the claim due to the fraud involved.    

Norma Corralejo v. United Airlines W.C. No. 5-038-089 (April 16, 2020)

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

From the June 2020 Newsletter

2020-07-06T15:43:32+00:00