Allen & Gooch is proud to report that its attorneys were able to reverse a default judgment obtained prior to their having assumed the handling of the file, able to obtain a favorable ruling for their client on the issue of 1208 fraud on the merits, able to have that ruling affirmed on appeal before the Third Circuit and, most importantly for future cases, were able to change the law in the Third Circuit to more closely aligned with the other circuits on the issue of retroactive forfeiture of benefits based upon Worker’s Compensation fraud.
More specifically, before this ruling, there was no Third Circuit decision that effective forfeiture of Worker’s Compensation benefits prior to the date of the misrepresentation. This ruling paves the way for retroactive forfeiture in the Third Circuit if those unpaid benefits were disputed (which would seemingly apply in most cases.) This change in the law will allow employers and carriers who have meritorious fraud defenses to avoid paying back pay and back medical bills in the situation of a successful fraud ruling. In that way, those employers and insurers can avoid pyrrhic victory. This decision is also important because it provides further examples for future claims with fraud potential by demonstrating what evidence rises to the level to of “sufficiency of the evidence” for a fraud ruling.
Allen & Gooch is providing this legal update for informational purposes only. This article should not be construed as legal advice or a legal opinion as to any specific facts or circumstances. You should consult your own attorney concerning your particular situation and any specific legal questions you may have.