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Certifying unemployment on workers’ compensation eligibility form may not be fraud.

January 1, 2019
Donato Carmona v. WM Mechanical, (IAB No. 1370142 – Decided Aug. 22, 2018)

The Workers’ Compensation Fund alleged that in February 2016, the claimant knowingly provided a false statement when he indicated on the Workers’ Compensation Fund Eligibility Certification Form that “I have not been gainfully employed due to my industrial accident.” The Fund submitted a January 2016 medical record in which the claimant’s treating doctor indicated the claimant did assist with a family tire business by doing administrative work. The claimant admitted there was a family tire business that was owned by his wife, but he denied having any ownership interest himself. He further testified that in early 2016, he was in classes learning English and would go to the family business after class to do his homework. He acknowledged that he helped customers locate tires once or twice a week, but did not get paid. It was only later in 2016 that he began working for the tire business 20 hours per week and began getting paid.

The Board found the claimant’s testimony credible; that he was not being paid for helping with the tire business in early 2016. The Board further found that the medical record from the claimant’s doctor containing the January 2016 notation was not sufficient evidence that the claimant was “gainfully employed” at the time he completed the Eligibility Certification Form. According to the Board, the medical record showed that the claimant reported being enrolled in a college degree program and assisting with the tire business, which the Board indicated was the same explanation to which the claimant had credibly testified at the motion hearing. Therefore, the Board found that the evidence and all reasonable inferences to be drawn from it, considered in the light most favorable to the Fund, was insufficient to support a finding that the claimant had knowingly falsified a government document.


Case Law Alerts, 1st Quarter, January 2019

Case Law Alerts is prepared by Marshall Dennehey Warner Coleman & Goggin to provide information on recent developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. Copyright © 2019 Marshall Dennehey Warner Coleman & Goggin, all rights reserved. This article may not be reprinted without the express written permission of our firm.

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