The Appellate Division recently ruled that in order to prove fraud, thus disqualifying an injured worker from obtaining workers’ compensation benefits, an insurance carrier must prove three things: that that the injured worker acted purposefully or knowingly in giving or withholding information with the intent that he or she receive benefits, that the worker knew that the statement or omission was material to obtaining the benefit and that the statement or omission was made for the purpose of falsely obtaining benefits to which the worker was not entitled, Natalie Bellino v. Verizon Wireless, Docket No. A-1132-12T4 (Argued 9/10/13, Decided 3/19/14).
In this case, Ms. Bellino was accused of providing false, incomplete, and misleading information to her treating and evaluating doctors. The allegations included that she failed to disclose every medication she was taking to each doctor she saw, failed to reveal a substance abuse problem for which she takes medication to prevent relapse and that she failed to disclose her prior psychiatric treatment. The Judge of Compensation held, and the Appellate Division affirmed, that the evidence at trial did not prove that she purposely or knowingly provided false or misleading information. She testified that she tried to answer all the doctors’ question truthfully, but that she had seen many doctors several times and was not always certain of the times and dates of previous treatment. The Appellate Division stated that the anti-fraud provision is intended to root out fraudulent claims, not merely test an injured person’s ability to remember every detail of a lengthy medical history or to accurately determine what may be material for purposes of receiving treatment or other benefits.
The ruling in this case is a victory for New Jersey’s injured workers. It is in your best interests to be as thorough and complete as possible with any doctor that is treating you whether it is for a work related condition or not, but courts are not inclined to deny you benefits if you inadvertently omit facts. Please note that fraud is taken seriously in the Division of Workers’ Compensation and any intentional behavior will result in forfeiture of benefits and subject you to civil and criminal penalties.
If you were injured on the job and have questions about your rights and benefits, please call Stark & Stark for a free, confidential consultation. We look forward to working with you.