Court Allows Employee’s Workers’ Compensation Claim Despite Substantiated Claims of Dishonesty

Earlier this month, an appellate court issued a written opinion in a California workers’ compensation case requiring the court to determine if an employee’s misdemeanor conviction for workers’ compensation fraud per se precluded him from recovering benefits for his injury. The court concluded that the employee may still be eligible for workers’ compensation benefits, notwithstanding the fraudulent conduct, if there is independent evidence of a compensable injury.

The Facts of the Case

The claimant was an employee at a car dealership. One day, while on the job, the employee slammed his hand in the trunk of a vehicle. No bones were broken, but the employee was unable to continue work due to the pain in his hand and shoulder. The employee filed a workers’ compensation claim.

For four years, the employee received workers’ compensation benefits and also was provided with medical care. However, the evidence suggested that the employee was not entirely receptive to the medical treatment provided and would at times refuse to allow the doctors to examine him or perform certain exercises on his hand. Notwithstanding his lack of cooperation, the employee was treated with opioid painkillers.

The employer hired a private investigator, who followed the employee around. The investigator filmed the employee taking off his sling and using his hand to drive and carry groceries. The video was then used to prosecute the employee for workers’ compensation fraud. During the pendency of that case, the employee was still provided with medical treatment and was more receptive and cooperative. The examining doctor viewed the video and, despite the exaggerating of the employee’s symptoms, determined that the use of his hand was severely compromised. The employee later pleaded guilty to insurance fraud.

Last year, the Workers’ Compensation Appeals Board found that the employee suffered from a 70% permanent disability and awarded benefits accordingly. The employer appealed this decision, arguing that the employee’s conviction for fraud should preclude him from receiving benefits.

The court affirmed the Board’s granting of benefits to the employee. The court began by explaining that a conviction for fraud cannot forever bar a worker from obtaining benefits. Therefore, in order to preclude a benefits award, the fraud must be related to the issuance of the award. In other words, if there is still sufficient evidence of an injury once the fraudulent conduct is no longer considered, a finding in favor of the employee is appropriate.

Here, the court noted that the examining doctor viewed the video and still believed that the employee suffered from a permanent disability. The doctor explained that the employee’s exaggerated symptoms did not mean that there was not a serious underlying injury. Thus, the employee’s workers’ compensation benefit award will stand.

Have You Been Injured on the Job?

If you have recently been injured while on the job, you may be entitled to California workers’ compensation benefits. The dedicated California workers’ compensation attorneys at Sharifi Firm have extensive experience handling cases arising from workplace accidents. To learn more, and to speak with an attorney about your case, call 866-422-7222 to schedule a free consultation.

More Blog Posts:

Plaintiff’s Case Permitted to Proceed Against Private Company Responsible for Maintaining Traffic Lights, Southern California Injury Lawyer Blog, November 13, 2017

California Car Accident Plaintiff Misses Out on Opportunity to Cross-Examine Defense Medical Expert, Southern California Injury Lawyer Blog, October 19, 2017

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