“The Alzate Doctrine” – Repeated Omissions about Prior Injuries Justify Permanent Disqualification under Workers' Compensation Law § 114-a

1. Introduction

Case: Matter of Alzate v. Quality Building Services Corp., 238 A.D.3d 1437 (3d Dept. 2025)
Court: Appellate Division of the Supreme Court, Third Department, New York
Date: 29 May 2025
Parties:

• Appellant/Claimant: Ms. Adriana Alzate
• Respondents: Quality Building Services Corp. (Employer) & its Insurance Carrier
• Administrative Agency: New York Workers’ Compensation Board (“the Board”)

The decision addresses whether a claimant’s repeated failure to disclose significant pre-existing neck and back conditions constitutes a knowing misrepresentation that triggers both the mandatory forfeiture and the discretionary penalty of permanent disqualification from future wage-replacement benefits under Workers’ Compensation Law § 114-a. The Third Department affirmed the Board’s imposition of the harshest available sanction, thereby crystallising what this commentary labels the “Alzate Doctrine”.

2. Summary of the Judgment

After a 2019 workplace accident involving a falling printer, Ms. Alzate’s claim was established for back, neck and right-shoulder injuries. During multiple Independent Medical Examinations (IMEs) and at a sworn hearing, she denied any prior neck or back injuries. Documentary evidence, however, showed extensive treatment for those very body parts between 2009 and 2019, including emergency-room visits, physical therapy, and imaging studies.

The Workers’ Compensation Law Judge initially found insufficient evidence of fraud. On administrative review, the Board disagreed, finding numerous “inconsistent and contradictory disclosures” and imposed:

1. Rescission of all wage benefits already paid that were directly attributable to the misrepresentation (mandatory penalty).
2. Permanent disqualification from all future indemnity benefits (discretionary penalty).

The Appellate Division unanimously affirmed, holding that substantial evidence supported the Board’s finding of a knowing, material omission and that the penalty was not “shocking to one’s sense of fairness”.

3. Analysis

3.1 Precedents Cited and Their Influence

• Matter of Carpenter v. Albany Dialysis Ctr., 235 A.D.3d 1048 (2025) – Quoted for the statutory definition of disqualification under § 114-a and the standard of review (“substantial evidence”).
• Matter of Williams v. New York City Dept. of Corr., 188 A.D.3d 1382 (2020) – Emphasised that omissions, not only affirmative lies, can be material false statements.
• Matter of Nappi v. Verizon N.Y., 205 A.D.3d 1181 (2022) – Recognised that exaggerating symptoms or downplaying pre-existing conditions may amount to misrepresentation; relied upon for “repeated omissions” rationale.
• Matter of Yolas v. New York City Tr. Auth., 224 A.D.3d 1112 (2024) – Restated that credibility findings lie with the Board.
• Matter of Ali v. New York City Dept. of Corr., 205 A.D.3d 1247 (2022) – Governs proportionality review of discretionary penalties; cited to justify permanent disqualification.
• Matter of Ortiz v. Calvin Maintenance, 199 A.D.3d 1211 (2021) – Another example of affirming disqualification for egregious misstatements.
• Additional citations (Bonilla, Puccio, Hartman, Arena) clarified preservation and procedural standards.

3.2 The Court’s Legal Reasoning

The Third Department applied a two-step framework:

1. Violation Determination. A fact is “material” if it is “significant or essential” to the claim. Medical causation and apportionment hinge on a claimant’s prior condition; hence, undisclosed back and neck pathology was material. The pattern—multiple IMEs, forms, and sworn testimony—showed a “knowing” omission rather than an innocent oversight. The court stressed that language-barrier contentions were unpreserved; claimant instead argued “memory loss,” a credibility issue resolved against her by the Board.
2. Penalty Review. Quoting Ali, appellate review of the discretionary penalty asks only whether it is “so disproportionate … as to shock the conscience.” Repeated, sworn denials made the misconduct “sufficiently egregious,” making permanent disqualification appropriate.

“Exaggerating one’s symptoms and/or downplaying the significance of pre-existing conditions … have been found to rise to the level of a material, false misrepresentation.” — Nappi, relied upon in Alzate

3.3 Impact of the Judgment

• Heightened Disclosure Duties. Claimants must diligently disclose any prior injuries, treatments, or accidents involving disputed body parts; failure invites the severest penalties.
• Strategic Considerations for Counsel. Attorneys must vet C-3 forms, translator accuracy, and IME questionnaires. Post-Alzate, “I forgot” or language-barrier defenses are less likely to succeed if unpreserved.
• Administrative Practice. Carriers are incentivised to conduct thorough medical-history investigations and raise § 114-a earlier, knowing courts will uphold substantial penalties where misrepresentation is systemic.
• Precedential Weight. The decision comes from the Third Department—the forum that hears virtually all § 114-a appeals—giving it statewide influence until contradicted by the Court of Appeals.
• Equity and Finality. By affirming permanent disqualification, the court signalled that repeated deception threatens the integrity of the workers’ compensation system, justifying maximum sanctions.

4. Complex Concepts Simplified

• Workers’ Compensation Law § 114-a – A fraud provision; if a worker knowingly lies or omits a material fact to obtain benefits, the Board must:
  • Rescind benefits obtained because of the lie (mandatory).
  • May also bar the worker from some or all future benefits (discretionary).
• Material Fact – Any fact important enough to affect entitlement, amount, or causation. Prior similar injuries almost always meet this test.
• Independent Medical Examination (IME) – A medical evaluation by a doctor chosen by the employer/carrier to assess injury status.
• Workers’ Compensation Law Judge (WCLJ) – The trial-level adjudicator in comp cases.
• Substantial Evidence – “Less than a preponderance but more than a scintilla”; enough relevant proof that a reasonable mind might accept.
• Discretionary Penalty vs. Mandatory Penalty – The first is optional and based on seriousness; the second is automatic once a violation is found.

5. Conclusion

Alzate v. Quality Building Services Corp. establishes a clear, stringent precedent: Repeated, knowing omissions regarding pre-existing injuries constitute fraud sufficient to warrant permanent forfeiture of wage benefits. The Third Department’s affirmation underscores:

1. The breadth of “material misrepresentation” under § 114-a encompasses omissions at every procedural stage.
2. The Board’s findings on credibility and materiality receive deferential “substantial evidence” review.
3. Permanent disqualification is not “shocking” where deception is pervasive and sworn.

Dubbed here the “Alzate Doctrine,” the decision serves as a stern warning to claimants and their counsel: full honesty is indispensable in the workers’ compensation arena, and failure to adhere to that standard can forever close the door to indemnity benefits.