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John Machiaverna worked for the City of Newark as a firefighter since 1988. He filed a workers’ compensation claim for his left knee in 2008, alleging that repeated work stressors over many years caused extensive knee problems and a need for knee replacement surgery in May 2007. He contended that his knee problems were due to regular climbing of extension ladders and stairs, crawling through buildings and carrying people out of buildings. The City denied the claim and put petitioner to his proofs.
During the testimony at trial, petitioner was asked if he had ever suffered any injuries in his work career. He testified that he had no previous injuries to his knee or hip. That testimony fell apart on further questioning. He then admitted that he injured himself in 2002 when a piece of sheetrock gave way during a fire, causing injury to his left leg. He next admitted on cross examination that he had arthroscopic surgery on his left knee in April 2002.
The petitioner was seen by four IME doctors, two for each side. The Court noted that he “lied to all four doctors who examined him because he failed to disclose his prior left knee injuries.” The Judge also commented that he initially failed to admit to having prior knee surgery in April 2002 and failed to admit two incidents in 2001. The IME doctors testified in court, and their testimony was critical in proving fraud.
Dr. Canario for respondent said that petitioner had not told him about a previous surgery to his left knee in 2002. In the opinion of Dr. Canario, petitioner’s size and weight were major factors in his knee problems. Petitioner was six foot five inches tall and weighed 345 pounds. Dr. Wong for petitioner stated in testimony that petitioner had not told her about his 2002 knee surgery. Dr. Kulkarni for petitioner also said that petitioner had not told him about three prior knee injuries.
The Honorable Theresa Yang, Judge of Compensation, found that petitioner was not a credible witness. She held that in concealing his prior knee injuries and surgery, petitioner committed fraud as defined by the New Jersey Fraud Act, N.J.S.A. 34:15-57.4 She therefore dismissed the case.
On appeal, petitioner argued that his due process rights had been violated because he was “deprived of the opportunity to defend himself against the court’s allegations of fraud.” The Appellate Division categorically rejected that position. “There was sufficient evidence to support Judge Yang’s credibility assessments and her determination that a violation ofN.J.S.A. 34:15-57.4 (c) (1) had occurred.” The Appellate Division held that petitioner failed to prove an occupational claim.
This case is important because it shows that Judges of Compensation are following the statutory law under the New Jersey Fraud Act. It is not necessary for an employer to prove a claimant was working while on temporary disability benefits to establish fraud. That is just one issue in a fraud case. If a claimant deliberately misrepresents or conceals prior medical information that is relevant to the claim, that in itself constitutes fraud. The case also shows how important it is for defense counsel to get prior records, whether attacking credibility or attempting to prove fraud.
The case can be found at Machiaverna v. City of Newark, A-5848-11T3, (App. Div. July 18, 2013).