Jones Jones LLC is pleased to share that Diane Mandleur and her team recently secured the successful dismissal of a schedule loss of use (SLU) claim on behalf of a self-insured employer (SIE), preventing Section 114-a fraud.
In this case, the claimant alleged slip and fall injuries to the right shoulder, right elbow, right knee, right ankle and right tarsal tunnel syndrome. A causal relationship was established with the independent medical examiner (IME) finding SLU of 98.3% to the right arm, 40% to the right leg and 15% to the right ankle. These permanency numbers were unusually high, leading Diane and her team to look more closely at the case when the claimant put forth a second Occupational Disease, Notice, and Causal Relationship (ODNCR) claim for the back and the right hip in 2025.
As the second matter was litigated, the team investigated the claimant and upon finding evidence the claimant was operating a business, advised the SIE to conduct additional research on the claimant’s work status. During this discovery, Jones Jones urged the IME to secure the claimant’s testimony that they were not working.
During a July 2026 hearing, the Jones Jones team presented the IME’s testimony and substantial evidence that the claimant was working despite their previous statement. The law judge ultimately found the claimant to be in violation of Section 114-a, dismissing the SLU claim and barring the claimant from receiving any future monetary awards due to the claimant’s egregious behavior and inconsistent statements to their doctors and the IME. This finding both saved the SIE an additional $200 to $300,000 in monetary awards and prevented future Section 114-a fraud.
Congratulations to Diane and her team for the dismissal of this claim. If you need assistance with a workers’ compensation case, please contact our team at concierge@jonesjonesllc.com. We take claims of fraud seriously.
