Surveillance-Supported Misrepresentation and Lifetime Disqualification Under WCL § 114-a

Introduction

Matter of Tirado v. Symphony Space, Inc. (2025 NYSlipOp 01842) addresses the application of Workers’ Compensation Law § 114-a when a claimant is accused of knowingly misrepresenting the extent of his injury in order to obtain benefits. Alejandro Tirado, a maintenance worker, sustained separate workplace injuries in 2013—first to his shoulders and right arm and then to his right ankle (with consequential back, heel and psychological injuries). Between 2018 and 2021 the carrier produced surveillance videos showing Tirado performing physically demanding tasks—often on the same days he attended independent medical examinations (IMEs) where he portrayed himself as severely disabled. The Workers’ Compensation Board (the “Board”) found that those misrepresentations violated § 114-a, imposed a mandatory forfeiture of benefits for the period covered by the videos, and exercised its discretion to bar Tirado from all future wage replacement benefits. Tirado appeals that decision.

Summary of the Judgment

The Appellate Division, Third Department, affirmed the Board’s decision in full. It held that:

Tirado knowingly made false representations of material fact under WCL § 114-a by feigning or exaggerating his disability during multiple IMEs.
There was substantial evidence—most notably the surveillance videos spanning 2018–2021—and credible medical testimony supporting the finding of misrepresentation.
A mandatory penalty disqualifying Tirado from wage replacement benefits for the period February 13, 2018 through March 4, 2021 was properly imposed.
The Board did not abuse its discretion in imposing a lifetime bar on future wage replacement benefits, given the egregious and protracted nature of the deception.

Analysis

Precedents Cited

Matter of Losurdo v. Asbestos Free (1 NY3d 258): Defines “material fact” as one significant or essential to the matter at hand.
Matter of Brown v. Van Liner Ins. Co. (227 AD3d 1331): Confirms that omission of material information can constitute a knowing misrepresentation under § 114-a.
Matter of Deliso v. New York City Tr. Auth. (225 AD3d 1010): Establishes that feigning or exaggerating disability meets the standard for a false representation and discusses the mandatory versus discretionary penalty framework.
Matter of Strohschein v. Safespan Platform Sys. Inc. (207 AD3d 818): Reinforces the need for substantial evidence of misrepresentation and validates the Board’s penalty discretion.
Matter of Rodriguez v. Burn-Brite Metals Co. (1 NY3d 553): Clarifies that the Board cannot cut off medical benefits under § 114-a but may disqualify wage replacement.

These authorities underpinned the court’s conclusions regarding the definitions of materiality, the allowable scope of Board penalties, and the proper standard of review (substantial evidence and abuse of discretion).

Legal Reasoning

The court’s reasoning proceeds in two phases:

Violation of § 114-a: The statute disqualifies any claimant who “knowingly makes a false statement or representation as to a material fact” to obtain or influence compensation. The Board, as fact–finder, credited multiple surveillance videos showing Tirado:
- Walking unaided with a normal gait when not attending IMEs, despite using a cane during examinations.
- Lifting heavy items, ascending and descending stairs, and performing labor-intensive tasks inconsistent with his claimed 50–75% disability levels.
Independent medical examiners, after reviewing the videos, revised their disability ratings downward from 75% to 25% or less and questioned the need for further surgery or home confinement. The Board thus held that Tirado “magnified his symptoms” and that his misrepresentations were “material” to the benefit determinations.
Penalty Analysis:
- Mandatory penalty: § 114-a(1) requires disqualification from any compensation “directly attributable” to the false representations. The Board disqualified Tirado for the exact period the surveillance videos covered.
- Discretionary penalty: The Board may bar future wage benefits when the misconduct is “egregious or severe.” Here, the WCLJ described Tirado’s conduct as “the most egregious example of false representation” encountered in years of service. Under the “abuse of discretion” standard, a penalty is upheld unless it shocks “one’s sense of fairness.” The Appellate Division found no such abuse, noting the breadth and duration of Tirado’s deception.

Impact on Future Cases

This decision solidifies several key points for practitioners and claimants:

Surveillance evidence, when credibly tied to misrepresentation allegations, can decisively prove material falsity and support both mandatory and discretionary penalties.
The Board’s broad discretion in imposing a lifetime bar will rarely be disturbed absent a penalty so disproportionate that it “shocks the sense of fairness.”
Claimants must present consistent physical portrayals across all examinations; any marked discrepancy documented by reliable video or photographic proof will strongly favor the carrier’s position.
The case reaffirms that exaggeration of symptoms—physical or psychological—is equally subject to § 114-a’s prohibitions and penalty scheme.

Complex Concepts Simplified

Workers’ Compensation Law § 114-a: A statute that disqualifies anyone who knowingly lies or omits material facts to gain or influence compensation, mandating benefit forfeiture and allowing a bar on future benefits.
Material Fact: Any detail crucial to the outcome of a workers’ compensation determination—here, the true extent of injury and disability.
Independent Medical Examination (IME): A medical evaluation ordered by the carrier to assess the claimant’s condition; critical because misrepresentation at an IME is a direct attempt to influence benefits.
Substantial Evidence: The standard of review for factual findings; requires more than a scintilla of evidence, though not proof beyond a reasonable doubt.
Abuse of Discretion: The standard for reviewing discretionary penalties; the Board’s decision will stand unless it is egregiously unfair or wildly disproportionate.

Conclusion

Matter of Tirado v. Symphony Space, Inc. reinforces that the Workers’ Compensation Board may rely on surveillance to expose ongoing misrepresentations and that egregious, protracted deception can warrant a lifetime bar from future wage benefits. The decision clarifies the interplay between mandatory forfeiture and discretionary penalties under § 114-a, underscores the weight of “material” misstatements in compensation proceedings, and reaffirms the high threshold for upsetting the Board’s credibility findings and penalty determinations. Claimants should take heed: consistency of presentation and candor in IMEs are indispensable to preserving both current and future benefits.