JCC Rejects Fraud Defense and Orders Ongoing Back and Neck Care

In Railing v. Southern Development & Construction Inc./Bridgefield Employers Insurance Company, Judge Jill E. Jacobs addressed petitions involving an accepted April 28, 2020 heavy-equipment accident with compensable neck and low back injuries.

The employer/carrier denied the entire claim under the fraud and misrepresentation provisions, relying on years of surveillance, deposition testimony, medical opinions, vocational reports, and a statute-of-limitations defense. The claimant sought interest and penalties on impairment benefits, temporary indemnity, and authorization for a return appointment with his authorized orthopedic physician.

The JCC credited the claimant's testimony and found the surveillance dated and unpersuasive. The order concluded that complaints about pain and work ability were not false or misleading and were not made with the intent to obtain workers' compensation benefits, so the fraud and misrepresentation defenses failed.

The order also rejected the statute-of-limitations defense, found the income impairment benefits were timely paid after overall MMI, and denied temporary total or temporary partial disability benefits for the claimed period.

The claimant did secure reinstated medical care. The JCC granted authorization and scheduling of a return appointment with Dr. Richard Smith for ongoing palliative care, awarded entitlement to attorney fees and taxable costs for defeating the defenses and securing medical benefits, and dismissed the petitions with prejudice. OJCC Case No. 21-005009JEJ.

Source: Compensation Order