An Inaccurate Accident Account Does Not Establish Workers’ Compensation Fraud Without a Benefits-Related Purpose

Matter of Castillo Gonzalez v Expo Concrete, LLC
2026 NY Slip Op 05833 — Appellate Division, Third Department — October 8, 2026

The supplied opinion is uncorrected and subject to revision before publication in the Official Reports.

1. Introduction

This decision addresses the consequences of a workers’ compensation claimant giving different accounts of the same workplace accident. Bernardo Castillo Gonzalez, a carpenter employed by Expo Concrete, LLC, initially reported that he had tripped over material on the floor. He subsequently told his treating physician, and stated in his compensation claim, that he had fallen through broken plywood flooring to the level below.

The employer and its workers’ compensation carrier, collectively described in the opinion as the “carrier,” challenged the Workers’ Compensation Board’s decision to add neck and back injuries to the established claim. Their appeal raised three questions:

  1. Whether the Board should have considered an objection to the adequacy of accident notice after the carrier failed to challenge the earlier decision establishing the claim.
  2. Whether the claimant’s admittedly inaccurate initial account constituted a violation of Workers’ Compensation Law § 114-a.
  3. Whether competent medical evidence supported a causal connection between the workplace accident and the additional neck and back injuries.

The Third Department unanimously affirmed the Board’s decision. The opinion’s principal significance is its distinction between an inaccurate statement and a statutory benefits-related misrepresentation. It applies established law rather than announcing a blanket exemption for false accident reports: a § 114-a violation requires the statutory purpose of obtaining benefits or influencing a benefits determination, and the Board’s supported credibility findings remain central to that inquiry.

2. Background and Summary of the Opinion

The accident and differing accounts

On April 20, 2023, Gonzalez told his employer that he had tripped over material while working and injured his face and left arm. Hospital personnel diagnosed an orbital wall fracture, a subdermal hematoma, and a left forearm contusion.

On May 4, 2023, his treating physician recorded a different history: Gonzalez said that he had fallen from a height of 10 feet. Following an examination, the physician identified several causally related injuries, including injuries to the neck and back. Gonzalez’s C-3 claim form, filed on May 11, 2023, stated that plywood had broken beneath him, causing him to fall to the ground below.

The administrative proceedings

On September 5, 2023, a Workers’ Compensation Law Judge established the claim for a facial bone fracture and a left elbow injury, while finding prima facie medical evidence of neck and back injuries. The carrier did not appeal that decision.

During later proceedings concerning the additional injury sites, the carrier raised inadequate notice and a § 114-a violation. In March 2024, the Law Judge added the neck and back injuries, found that the employer had received proper notice, and determined that the evidence did not establish a § 114-a violation.

In its March 31, 2025 decision, the Board declined to review the notice challenge because the carrier had not appealed the September 2023 decision. It otherwise affirmed the Law Judge’s determinations.

The appellate decision

The Third Department affirmed on all three issues:

  • Notice: The differing accident accounts were documented before the initial claim-establishment decision. Given the carrier’s opportunity to raise the issue and its failure to appeal, the Board did not abuse its discretion by declining to address the later notice objection.
  • Section 114-a: The Board credited Gonzalez’s explanation that his initial account was intended to protect coworkers and the employer from trouble, not to obtain compensation benefits. Substantial evidence supported that determination.
  • Causation: The treating physician’s opinion, supported by examination findings and the Board’s credibility assessments, supplied substantial evidence for adding the neck and back injuries.

The decision was affirmed without costs.

3. Analysis

A. Precedents Cited and Their Influence

The cited authorities form three distinct lines of precedent: administrative review and finality, statutory misrepresentation and credibility, and medical causation. Their significance below is confined to the propositions for which the supplied opinion invokes them.

Administrative review and the unchallenged earlier decision

Matter of White v Fuji Bank, Ltd., 8 AD3d 817, 817–818 [3d Dept 2004]

The court cited this case with Workers’ Compensation Law § 123 when finding no abuse of discretion in the Board’s refusal to address the belated notice objection. Its role is to support deference to the Board’s handling of an issue that could have been raised before an earlier determination. Here, the decisive circumstances were the existing documentation of inconsistent accounts and the carrier’s failure to challenge the September 2023 decision.

Matter of Imbriani v Berkar Knitting Mills, 277 AD2d 727, 730 [3d Dept 2000]

Cited alongside Workers’ Compensation Law § 23, this authority reinforces the importance of timely administrative review. It supports the court’s refusal to treat the later proceedings over additional injuries as an unrestricted opportunity to revisit an objection available when the original claim was established.

The elements of a § 114-a violation

Matter of Augone v Stop & Shop Supermarket Co. LLC, 236 AD3d 1283, 1284 [3d Dept 2025]

This case supports the statutory formulation requiring a knowingly false statement or representation concerning a material fact, made for the purpose of obtaining benefits or influencing a related determination. It helps frame why proof of an inaccurate account, standing alone, does not complete the statutory inquiry.

Matter of Linane v Gristede's Food Inc., 231 AD3d 1219, 1219 [3d Dept 2024]

The court cites this decision for the same statutory framework. Its contribution is to anchor the analysis in the elements prescribed by § 114-a rather than in a general judgment that a claimant who has been untruthful must necessarily lose compensation.

Matter of Ordaz v Jerrick Assoc. Inc., 194 AD3d 1331, 1332 [3d Dept 2021]

This authority also supports the statutory rule, including disqualification from compensation directly attributable to the qualifying false statement. Together, these three decisions establish the framework within which the Board had to assess Gonzalez’s admitted misrepresentation.

Credibility, purpose, and appellate deference

Matter of Alzate v Quality Bldg. Servs. Corp., 238 AD3d 1437, 1438–1439 [3d Dept 2025], lv denied 44 NY3d 910 [2026]

The opinion quotes this decision for the principle that whether a claimant violated § 114-a lies within the Board’s province, that the Board is the sole arbiter of witness credibility, and that its decision will stand if supported by substantial evidence. This principle directly limits the appellate court’s role: it reviews evidentiary support rather than independently deciding whether to believe Gonzalez’s explanation.

Matter of Bennett v J-Track LLC, 182 AD3d 967, 969 [3d Dept 2020]

This case supplies additional support for the Board’s authority over credibility and the substantial-evidence standard. It reinforces the distinction between a carrier identifying a credibility problem and demonstrating a basis for overturning the Board’s resolution of that problem.

Matter of Hartman v Arric Corp., 224 AD3d 959, 961 [3d Dept 2024]

The court cites this authority when sustaining the conclusion that the initial misrepresentation was not made to obtain benefits. Its placement emphasizes that the statutory purpose is a necessary part of the analysis and that the Board’s supported assessment of the claimant’s explanation can be decisive.

Matter of Wait v Hudson Val. Community Coll., 120 AD3d 1456, 1457 [3d Dept 2014]

This decision likewise supports leaving undisturbed the finding of no § 114-a violation. In the present opinion, it reinforces a fact-sensitive approach to purpose, rather than an automatic equation of inconsistent accident histories with compensable fraud.

Medical proof and causation

Matter of Maldonado v Doria, Inc., 192 AD3d 1247, 1248 [3d Dept 2021]

The court quotes this case for the claimant’s burden to establish a causal relationship between the injuries and employment through competent medical evidence. It makes clear that acceptance of Gonzalez’s explanation for the inconsistent accounts did not eliminate his separate obligation to prove the additional injuries were work-related.

Matter of Blanch v Delta Air Lines, 204 AD3d 1203, 1205 [3d Dept 2022]

This authority further supports the medical-proof requirement. Its role is to distinguish a claimant’s account of the accident from the medical evidence needed to connect particular injury sites to that accident.

Matter of Brown v Van Liner Ins. Co., 227 AD3d 1331, 1333–1334 [3d Dept 2024]

The court first invokes this case for the Board’s authority to determine causation from the record, subject to substantial-evidence review. It cites the case again when upholding the amendment of the claim. The authority thus supports both the governing review standard and the conclusion that the medical record adequately sustained the Board’s finding.

Matter of Flores v Millennium Servs., LLC, 215 AD3d 1146, 1147 [3d Dept 2023]

This decision supplies additional support for treating causal relationship as a factual issue for the Board. It reinforces that appellate review does not involve deciding causation anew where substantial evidence supports the administrative determination.

Matter of Brennan v Village of Johnson City, 213 AD3d 1058, 1059 [3d Dept 2023]

The opinion cites this case both for the Board’s role in determining causation and for deference to its assessment of medical credibility. Its dual use connects the sufficiency of medical evidence with the Board’s responsibility to evaluate that evidence.

Matter of Martinez v RNC Indus., LLC, 213 AD3d 1109, 1110–1111 [3d Dept 2023]

The court quotes this decision for the Board’s discretion to assess medical witnesses and the especially strong deference accorded to its resolution of causation issues. It also relies on the case in affirming the addition of the neck and back injuries. This authority explains why the treating physician’s credited opinion could sustain the result despite the consultant’s failure to offer a causation opinion.

B. Legal Reasoning

1. The notice issue turned on procedural history, not a fresh ruling on adequacy

The carrier argued that the inaccurate initial account meant the claimant had not provided proper notice under Workers’ Compensation Law § 18. The appellate court did not decide that every inaccurate description satisfies that statute. Instead, it examined when the carrier could have identified and raised its objection.

The May 4 medical report and May 11 claim form disclosed the differing accounts before the September 2023 decision. The discrepancy therefore was not newly revealed during the proceedings concerning neck and back injuries. The record did not show that the carrier raised the issue before the initial decision, and the carrier did not appeal that decision.

Against that background, the court held that the Board acted within its discretion in declining to address the later objection. The holding is consequently narrower than a categorical rule that establishment of a claim always bars every subsequent notice issue. It rests on the carrier’s prior opportunity to object and its failure to seek timely review.

2. An admitted false account did not establish the required benefits-related purpose

Gonzalez admitted that his initial account was inaccurate. The Board nevertheless had to determine whether that statement met the requirements of § 114-a, including the purpose for which it was made.

He testified that coworkers had warned him that reporting a fall through the floor could cause trouble for them and the employer and could cost the coworkers their jobs. He also explained that he was in pain and wanted to reach the hospital quickly. The Board credited his explanation of his motivation.

Several circumstances supported the Board’s assessment. Gonzalez subsequently disclosed the fall from height to his treating physician; the carrier’s consultant knew both versions; and the carrier did not dispute that a fall occurred while he was working. The consultant also found that the reported complaints were consistent with objective clinical findings.

The court therefore upheld the determination that the original misrepresentation was not made for the purpose of obtaining benefits. It did not declare the accident mechanism legally immaterial, nor did it suggest that protecting coworkers invariably excuses a false statement. The result depended on the credited explanation and the surrounding record.

3. The claimant still had to prove the additional injuries medically

The treating physician expressly connected the neck and back injuries to the workplace fall. That supplied affirmative medical evidence of causation. The carrier’s consultant did not offer a causation opinion, although the consultant found the claimant’s complaints consistent with objective examination findings.

This distinction matters: findings consistent with an injury are not, by themselves, an opinion identifying what caused it. The consultant’s report provided supporting clinical context; it did not independently establish the causal relationship. The treating physician supplied the necessary causal opinion, which the Board credited alongside Gonzalez’s testimony.

The court found substantial evidence for adding the neck and back injuries. The earlier finding of prima facie medical evidence was only a preliminary step and did not replace the later assessment of whether the claimant had established causation.

4. The three issues remained legally distinct

The opinion does not collapse procedural notice, statutory misrepresentation, and medical causation into a single credibility question. Each required a separate analysis: notice implicated the unchallenged earlier decision; § 114-a required examination of statutory purpose; and amendment of the claim required competent medical evidence. This separation is an important feature of the court’s reasoning.

C. Potential Impact

For employers and carriers: The decision underscores the need to review accident histories promptly and preserve objections through timely administrative challenges. An inconsistency already documented before claim establishment may not provide a later opportunity to reopen a notice dispute during proceedings about additional injury sites.

For claimants: An inaccurate account remains a serious credibility concern, but it does not automatically establish a § 114-a violation. A credible explanation, subsequent disclosure, and supporting medical evidence can affect the outcome. The opinion is not permission to provide false information; a knowing, material falsehood made for the statutory benefits-related purpose remains subject to § 114-a.

For future litigation: The decision directs attention to why a statement was made, not merely whether it differed from a later account. It also confirms that inconsistent histories do not necessarily defeat causation when competent medical evidence and credited testimony support the Board’s determination.

For appellate practice: The opinion illustrates the different review standards operating within one appeal. The refusal to entertain the notice issue was reviewed for abuse of discretion, while the misrepresentation and causation determinations were upheld under substantial-evidence review. Neither standard authorized the court simply to substitute its preferred factual conclusions for the Board’s supported findings.

4. Complex Concepts Simplified

Workers’ Compensation Law § 18: notice

This provision concerns notice of a workplace accident. Here, the appellate court resolved the notice challenge through the procedural history rather than newly deciding whether the original description was sufficient.

Workers’ Compensation Law § 114-a

This provision addresses knowing false statements about material facts made to obtain compensation benefits or influence a related determination. A statement’s falsity does not, by itself, establish all of those requirements.

Material fact

A fact significant to the relevant benefits determination. The court did not hold that the mechanism of a workplace fall can never be material; its analysis focused on the claimant’s purpose.

Substantial evidence

Evidence adequate to support the Board’s conclusion. Appellate review asks whether that support exists, not whether the judges would have reached the same factual conclusion independently.

Abuse of discretion

A standard that asks whether the decision-maker exceeded the permissible bounds of judgment. Here, the Board permissibly declined to revisit the notice objection.

Prima facie medical evidence

Preliminary medical evidence sufficient to permit consideration of an alleged injury. It is not the same as a final determination that the injury is compensable.

Causal relationship

The connection between the workplace event and the claimed injury. For the neck and back injuries, the claimant needed competent medical evidence linking those conditions to his fall.

Amending an established claim

Adding recognized injuries to an existing workers’ compensation claim. The disputed amendment here concerned the neck and back, not every injury listed in the claimant’s original submission.

5. Conclusion

Matter of Castillo Gonzalez v Expo Concrete, LLC confirms that an inaccurate accident account does not alone establish a § 114-a violation. The statutory benefits-related purpose must also be established, and a supported Board finding about the claimant’s motivation receives appellate deference.

The decision also emphasizes timely preservation of notice objections and the independent need for competent medical proof when adding injury sites. Its broader significance lies in a disciplined, issue-specific approach: procedural default, misrepresentation, and causation each have their own requirements, even when all arise from the same inconsistent accident history.