Blogger and Larson's co-author Thomas Robinson wrote yesterday in his blog workcompwriter.com about a case where a New York Appellate Court upheld a decision to stop indemnity benefits to an injured worker because he had failed to report gambling income while receiving workers' compensation payments. Robinson, in his usual form, does an excellent job of outlining the events and informing us of the history of the case.

I, on the other hand, will stay true to my relatively lazy nature and simply provide a brief recap.

• 2007, worker is injured and starts collecting indemnity benefits.
• 2014, he pleads “guilty to attempted promoting gambling in the first degree.” As a result, a WCLJ found, and the Board later affirmed, that he had violated NY Statute § 114-a, and therefore a “discretionary penalty disqualifying claimant from receiving any future wage replacement benefits” was imposed.
• Injured dude appeals the decision.
• May 27, 2021, Appellate Court upholds the earlier decision.

As Robinson explained, as part of the guilty plea, the claimant admitted to collecting more than $5,000 in a single day in what are illegal gambling activities in the state. The gambling arrangement discussed in the plea occurred in 2011.

According to WorkCompResearch.com, NY § 114-a, titled “Disqualification for false representation,” states in part:

1. If for the purpose of obtaining compensation pursuant to section fifteen of this chapter, or for the purpose of influencing any determination regarding any such payment, a claimant knowingly makes a false statement or representation as to a material fact, such person shall be disqualified from receiving any compensation directly attributable to such false statement or representation. In addition, as determined by the board, the claimant shall be subject to a disqualification or an additional penalty up to the foregoing amount directly attributable to the false statement or representation. Any penalty monies shall be paid into the state treasury.

As noted, the infraction du jour occurred in 2011, but the case did not resolve until 2014. The appeal, if you have not yet applied your impressive ciphering skills, took an additional 7 years to wend its way through the system. That is 14 years from the initial injury.

Even the Emmy Awards don't run that long, although they seem to.

In this case, the length of time it took to process the case is probably not critical, since the initial determination removing benefits was upheld. But what if that initial decision had been wrong? What if an egregious error had been made, and a family was left unsupported for over 7 years? Would that seem right to anyone?

One of the biggest issues identified in the 2016 Workers' Compensation Summit was “Delays in Treatment for Compensable Claims” within the workers' compensation system. The timeline of this particular case could not be a better example, even if the outcome in this instance does not support the specific narrative.

It is not just delayed income that should be a concern. Delays in medical treatment are actually the bigger issue in many of these cases. Care that is delayed while lawyers wrangle often means more difficult treatment and poorer outcomes for the injured worker once their care is finally approved. And if you think those delays simply cost the injured worker, you would be sadly mistaken.

It would behoove us to remove as many obstacles and contradictions as we can when managing workers' compensation claims. Avoiding legal battles that are not based on solid foundations would be a good policy.

The legal wheels of justice turn slowly, and lives continue to hang in the balance. We should hedge our bets to make sure our reasons for that litigation are sound. Otherwise it is simply a wager where everyone eventually loses.

Comments

Be the first person to comment!