Author: Jones Jones

Jones Jones LLC Partner Rosanna Shamash won a Third Department decision in Juanita Jones v. New York City Transit Authority (https://decisions.courts.state.ny.us/ad3/Decisions/2022/534984.pdf). The underlying facts of this decision begin with a Law Judge’s determination that the claimant violated fraud Section 114-a by failing to disclose certain work activities.  Ultimately, the Law Judge sanctioned both mandatory and discretionary penalties; meaning that not only would the claimant have to pay money back, but also that she would no longer be qualified to receive any future indemnity payments arising from this claim. Upon appeal of this decision, the NYS Workers’ Compensation Board noted that the RB-89 portion of the claimant’s appeal was not fully completed and therefore the appeal was completely denied.  Partner Shamash was able to have this finding upheld before the Third Department despite the claimant raising a newly enacted law, WCL 23-a(1).  WCL 23-a(1) states, that “a mistake, omission, defect and/or other irregularity in a {form RB-89} accompanying an application for administrative review …shall not be ground for denial of said application.” Partner Shamash was able to skillfully highlight to the Court that the merits of the case support the finding of fraud and that WCL 23-a(1) does not apply to this matter as the legislation came into effect after the filing of the incomplete RB-89 by the claimant.

Congratulations to Partner Shamash for a great win!

Jones Jones LLC Attorney Katie Caracappa presented successful arguments before the Third Department Court in New York State and secured a win for the self-insured employer in the decision of Molander v. New York City Transit Authority (534520.pdf (state.ny.us)).  Based on Attorney Caracappa’s arguments, the Court found that the claimant’s wage loss was unrelated to his underlying Worker’s Compensation claim; ultimately saving the self-insured employer $110,000 in indemnity awards.

The case had previously been established for obstructive airway disease, gastroesophageal reflux disease, upper respiratory disease, and sleep apnea. The claimant  had not lost any time from work due these conditions since 2015, but thereafter maintained that he had stopped working in February 2020 due to his respiratory issues associated with his case.  The claimant took the position that his lung condition had deteriorated and he was no longer able to work.  However,  through litigation the Jones Jones LLC team was able to demonstrate that the reason the claimant had actually stopped working was unrelated to his underlying Worker’s Compensation claim. The claimant had been involved with some legal troubles out of state and disciplinary proceedings with the employer resulted in his work stoppage.  After reviewing the brief that Attorney Caracappa prepared,  The Third Department agreed that the claimant was not credible and found the reason that the claimant stopped working was unrelated to the underlying claim.

We are proud of another great appellate win from the Jones Jones team.  Congratulations Katie Carcapppa! Contact clientservices@jonesjonesllc.com should you or your team have any questions or need to connect with an attorney on appellate process.

Jones Jones LLC is excited to announce a major win secured by Partner Dana Sabghir and Associate Katherine Caracappa.

This win highlights:

• The necessity to thoroughly review medical records submitted by treating doctors. Oftentimes, these records have a detailed history of the claimant’s prior medical history and treatment. This review, coupled with the history as given by a claimant in initial claim documents (C-3) and history as given by claimant to IME doctors could vary greatly, and very well may be the basis of a fraud finding by the Workers’ Compensation Board;
• The importance of seeking full medical records by way of subpoena in order to obtain the full picture of the claimant’s health prior to the workers’ compensation accident date; and
• How detailed fraud litigation can have an impact on the workers’ compensation case as well as a corresponding costly general liability claim.
  Jones Jones LLC attorneys Dana Sabghir and Katherine Caracappa secured a major win for a construction company that resulted in the claimant paying a significant amount of money back to the carrier.

The claim involved a claimant construction laborer, who upon initial filings (C-3), denied any prior conditions or prior accidents. The claim was established for bilateral knees, elbow, and the back. Soon after this establishment of injury, the claimant’s attorney filed for a hearing with the intent of expanding the case to numerous body parts and conditions. Our Jones Jones LLC attorneys subpoenaed records from the doctors who had submitted medical evidence in support of expanding the case to numerous other body parts. Upon a thorough review of these records, it became evident that the injured worker actually did indeed have extensive prior treatment to the bilateral knees, elbow, and back. Additionally, these prior records made reference to multiple prior accidents, prior surgeries, as well as significant results on diagnostic tests pre-dating our injury date in question. The claimant had also begun denying prior injuries to several of his own doctors as well as the independent medical consultants on the case. The misrepresentation of the prior physical condition of the claimant was spread not just to the documentation filed with the NY Workers’ Compensation Board; but also to the doctors tasked with treating the claimant’s injuries.

Jones Jones LLC raised fraud under WCL Section 114-A and requested that the Law Judge enter a formal finding that the claimant committed a material misrepresentation. The fact that prior injuries, surgeries, and conditions were denied on the initial claim filing documents as well as denied to a variety of doctors during treatment and evaluation was the basis for this request for a fraud finding.

Following litigation, the Law Judge did find that the claimant violated Section 114-A fraud as the claimant committed a material misrepresentation as it related to his prior physical condition. The New York State Workers’ Compensation Board held that the claimant was required to pay the insurance company approximately $40,000.00 back in workers’ compensation benefits as well as be permanently disqualified from receiving future indemnity benefits.

Additionally, as the accident in question involved a construction site accident, the claimant had a corresponding general liability claim. The fraud finding on this claimant’s workers’ compensation case had had significant impact on the future of the claimant’s general liability claim and his ability to close that case with a monetary gain.

Contact our attorneys today at clientservices@jonesjonesllc.com for any need you have regarding a fraud evaluation.