The Court decided the case pursuant to the Workers’ Compensation Fraud Act (N.J.S.A. 34:15-57.4). In this case, the petitioner originally received workers’ compensation benefits as a result of a workplace accident. However, the petitioner subsequently received medical treatment for a preexisting knee injury that medical records showed the petitioner suffered prior to the current accident. The petitioner argued that any misstatement was not made knowingly or purposely as she did not know the specific diagnosis for her prior knee injury.
In coming to its decision, the Court concluded that it did not matter that petitioner did not know the specific diagnosis. When questioned by the company’s doctor, the petitioner did not reveal to that doctor that she had any kind of prior knee injury. This statement was contradicted by medical records that indicated that petitioner did, in fact, have a prior knee injury. Therefore, the petitioner was denied medical and temporary benefits, and was ordered to repay the costs of all treatments she had received to date.
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