Injured trucker's workers' comp preserved after it was curtailed for 'writing career'
The trucker contends he wrote and sold works of fiction as a hobby. His writing career, which started before the injury, earned him around $40 annually.
New York state officials forced a truck driver for U.S. Concrete to turn back $93,155 in workers’ compensation benefits from October 2017 through September 2020 for failing to disclose that he self-published four fictional books after his on-the-job injury.
But an Albany appeals court declined to dig deeper into the driver’s pockets on Thursday, rejecting his employer’s request for a discretionary penalty to rescind the worker’s partial disability benefit of $802 per week from September 2020 onward.
The record showed that the driver hadn’t tried to disguise his writing and publishing endeavors, such as adopting a pen name, and was forthcoming about his activities when questioned by a workers’ compensation law judge, Justice Lisa Fisher wrote in the unanimous order of the state Supreme Court, Third Department, Appellate Division.
The driver made less than $40 a year publishing seven books, including three before the injury, as a “hobby,” according to the injured worker’s attorney, Geoffrey Schotter of Schotter Millican in New York City.
The case illustrated the lengths to which insurance companies will go to “abuse” the provisions of workers’ compensation law regarding alleged acts of fraud, Schotter said.
“In this particular case, the guy was found to have violated [the law] technically,” Schotter said. “But even that wasn’t good enough for this company. They took the trouble and the expense of trying to appeal it. It’s not enough that you were found guilty and you disqualified him.
Paul Elyash of Weiss, Weller & Wornow of New York City filed the appeal on behalf of U.S. Concrete, Indemnity Insurance of North America, and third-party administrator Sedgwick Claims Management Services. Elyash did not return a message seeking comment.
Assistant Attorney General Nina Sas represented the Workers’ Compensation Board, which adopted the law judge’s March 2021 ruling that the case didn’t warrant a discretionary penalty.
The work accident occurred Oct. 19, 2017. John Koratzanis, who drove a mixed-concrete truck, was at a job site when his vehicle’s pump exploded. A steel pipe coupling blew off a hose and struck Koratzanis. The claimant injured his right leg, foot and ankle, both knees, and his left hip and lower back.
In August 2020, the appellant emerged with surveillance evidence that its lawyer said showed activities inconsistent with the disability and that Koratzanis had possibly worked.
The law judge held a hearing on Sept. 16, 2020, at which Koratzanis testified that starting in 2015, he self-published seven novels on Amazon for a total of $248 in sales.
The claimant had previously told the court that he hadn’t been able to work, prompting the mandatory penalty to suspend his workers’ compensation benefits when the law judge found that the appellants had made a sufficient offer of proof.
The law judge later explained that a discretionary penalty targeting Koratzanis’ benefits from September 2020 onward wasn’t warranted because the truck driver’s motivation for publishing his writings wasn’t to make money or to hold a profession.
The judge had also noted that the claimant’s Amazon document showed that he gave away significantly more books than he sold, and that this case differed from a 2020 Third Department case in which a workers’ compensation claimant was found to have sold clothing on Facebook.
“Workers’ compensation fraud has a profound impact on a system that is intended to help those who are truly injured,” New York Insurance Association President Ellen Melchionni said in a statement. “The insurance industry is dedicated to providing medical care and benefits to injured workers. Insurance companies also take their responsibility to investigate fraud very seriously. The industry is committed to helping those who are hurt while also ensuring that suspected fraudulent claims are carefully reviewed.”
The Office of the New York State Workers’ Compensation Fraud Inspector General received 1,118 complaints in 2021, according to its annual report.
Preliminary investigations of all complaints led to 28 full investigations, while 334 matters are ongoing and 51 complaints were closed for failing to allege actionable wrongdoing or a lack of jurisdiction. Another 492 matters were closed as unsubstantiated, and 213 complaints were referred to other agencies.
In January, the agency beefed up its probing of bogus claims with the appointment of an attorney in charge of workers’ compensation fraud, a new position.
Schotter conceded that there’s a tendency for dishonest claims to “try to game the system.”
“But if you would compare the number of workers’ comp claimants who actually, truly committed fraud to the number of claimants accused of fraud, in often frivolous ways, the latter I think would far outnumber the former,” he said.
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