NO INDUSTRIAL ACCIDENT:
Claimant's incredibility leads to denial of claim.
Kelley v. Aaron's Sales & Lease (pdf) - Claimant alleged injury to her low back for which she sought compensation and medical treatment in excess of $134,000.00. Discovery found evidence of deceit and how her injury might be related to her second job with a janitor company. Testimony sealed the deal. The I.A.B. ruled she failed to prove an accident occurred with our client.
NO INDUSTRIAL ACCIDENT:
Lack of accident and proof of drug seeking leads to denial.
Johnson v. Std. Pipe Servs. (pdf) - Claimant said she was thrown out of our client's truck. We argued that was impossible and that she sought drugs. The I.A.B. agreed and denied the claim.
NO INDUSTRIAL ACCIDENT:
The First Report of Injury cannot be used to prove injury.
Stone v. Murry Trucking (pdf) - Claimant alleged a neck injury. We argued there was no accident. He attempted to submit Employer's First Report of Injury to prove one. We objected. The I.A.B. agreed and denied the claim.
Claim denied when accident arose "out of" personal condition.
Norris v. Willis Chevrolet (pdf) - Claimant alleged her job caused her right knee to dislocate. We argued the injury was a congenital condition. The I.A.B. denied the claim.
Claim denied when accident did not arise "out of" employment.
Morales v. State of Delaware (pdf) - Claimant fainted at work and sued for compensation. Mr. Andrews argued that while the accident arose "in the course of" employment, it did not also arise "out of" employment. The State won on all counts.
AREA OF INJURY:
Surgery and treatment unrelated to recognized injury.
Hamilton v. Indep. Disp. Servs. (pdf) - The parties entered into Agreements for a lumbar injury in 2002. Employer paid over the next 12 years until Claimant sought surgery at L5-S1 and ongoing total disability. Claimant argued that our client's payments had accepted liability. The I.A.B. denied the claim. When he moved to reargue, the I.A.B. denied the claim again in Hamilton II (pdf). His claim was denied a third time after he appealed to the Superior Court in Hamilton III (pdf).
EXTENT OF INJURY:
Discovery of a pre-existing condition renders treatment unrelated and a finding that all injuries resolved.
Martinez-Lopez v. Chapman Hosp. (pdf) - Claimant alleged to have injured her ankle to such a degree that she was totally disabled from all work for over a year. We argued that any accident only caused a minor ankle roll, she had two intervening accidents and we should not be liable for total disability or ankle surgery. We won on all counts.
ADJACENT DISC DISEASE:
Claim for adjacent disc disease denied as unrelated to claim.
Hellstern v. Culinary Servs. (pdf) - The parties entered into an Agreement for injury at L3-L4 and to pay for spinal surgery thereto. During the surgery, Claimant's treating physician also fused L2-L3. Claimant and her physician then petitioned to force our client to pay for L2-L3 on the ground of adjacent disc disease. The I.A.B. denied the claim. Her claim was denied a second time when she appealed to Superior Court in Hellstern II (pdf).
Corporate Personhood / Certificate of Insurance.
Rivera v. Final Touch Constr. (pdf) - Claimant was injured during demolition, which was subcontracted to an entity named "Final Touch." The Certificate of Insurance listed our client (Markel) as the Carrier. Markel’s policy stated that it insured a sole proprietorship; yet, the COI listed Final Touch as a corporation. Discovery brought to light that the subcontractor owned four "Final Touches": One sole proprietorship and three corporations. We argued that each "Final Touch" needed separate insurance, that our policy only covered the sole proprietorship and that Claimant was not working for the sole proprietorship. Our client won on all counts.
PREVIOUSLY ACCEPTED CLAIM:
Corporate Personhood / Premium Fraud.
Skinner v. Barbutes (pdf) - A Carrier originally acepted compensability and paid over $10,000.00. It then discovered that the Employer owned two businesses: One was insured, the other was not. Claimant worked for the uninsured company when injured and Employer reported the claim as though he worked for the insured company. Mr. Andrews petitioned to dismiss the Carrier due to the fraud; hold the fraudulent party exclusively liable on the claim; and order the Employer to pay full indemnity to the Carrier for fraud. The Carrier won on all counts.
NO "INDUSTRIAL" ACCIDENT:
If it it's not industrial then it's not compensable.
Bullock v. Hollywood Motel (pdf) - Claimant and our client (Employer) had both an Employer / Employee relationship and a Landlord / Tenant relationship. She was injured when walking to deposit her rent check. We argued that this did not occur "in the course of her employment" but "in the course of her lease." The I.A.B. denied the claim.
Subpoenaed telephone records definitively settle dispute over proper employer between subcontractors.
Delgado v. CEM Enter. v. SM Contr's (pdf) - Claimant fell off a roof while working on a new construction site in Maryland for a Delaware Employer. Claimant stated he was working for CEM Enterprises when he filed his petition. CEM in turn alleged that they had no idea who the Claimant was but that he was actually employed by our client, SM Contractors, which CEM alleged was also working at that jobsite on the date of accident. Mr. Andrews argued that SM Contractors only had one "new construction crew," which was working in Delaware, not Maryland, on the date of accident. He also argued that accident reports from two separate companies that day listed CEM as the employer of the Claimant. Finally, he subpoenaed the telephone records of the Claimant, CEM's owners and SM's owners and proved the following: (1) Claimant received a text message from CEM the day before the accident offering to hire him for a job in Maryland; (2) after the accident there were multiple telephone calls between Claimant and the owners of CEM; and (3) there were no calls or text messages between Claimant and anyone with any relation to our client (SM) during any period of time. The Industrial Accident Board agreed on all counts and dismissed our client from all liability.
DRUG DEALING IS "EMPLOYMENT":
Selling illegal drugs is "employment" to deny liability just as bootlegging was "employment" during the Prohibition Era.
Burris v. Top Flight Flagging (pdf) - Claimant alleged "total disability" for over a year and sought $45,000.00 in unpaid total disability benefits; over $65,000.00 in unpaid medical expenses; and entitlement to ongoing medical treatment. Mr. Andrews discovered evidence of Claimant working as an end stage cocaine bagger in an underground cocaine distribution enterprise. Arguing that Claimant could not be "totally disabled" because drug dealing is "employment," he called a forensic narcotics expert to testify on this and presented Prohibition Era case law that supported this position. The I.A.B. agreed, denied all indemnity and held that any alleged injuries "resolved" so as to terminate all liability.
Agreement voided ab initio due to Claimant's fraud and full indemnity awarded to Employer.
Delaware Siding Co. v. Zuniga (pdf) - In April 2015 Claimant alleged that he injured his right knee as a result of employment with our client. In good faith our client offered to accept the claim as compensable and entered into an I.A.B. Agreement pursuant to which our client paid benefits. We later discovered that Claimant had actually injured his right knee while working for his own company and immediately filed a petition to void the Agreement and order Claimant to repay $115,142.90 in indemnity. We won on all counts.
Complex fraud discovered and indemnity awarded to Employer.
Beebe Hosp. v. Norwood (pdf) - For fifteen years the Claimant led multiple parties to believe that she was totally disabled. After discovering evidence that she had been employed throughout that time, Mr. Andrews filed a petition for review with the I.A.B., seeking a finding of fraud; retroactive dismissal of the open Agreement; and requesting Claimant to pay full indemnity of $114,120.00, dollar-for-dollar, plus legal costs. The Employer won on all counts.
I.A.B. orders indemnity for fraud against itself and Employer.
Bailey v. XPress Nurses (pdf) - Claimant sprained her wrist while working for our client and collected ongoing total disability. We discovered that she had been working full duty for another employer the whole time, immediately petitioned to terminate the Agreement for fraud, have her reimburse all money fraudulently obtained and have her referred for criminal proceedings for criminal fraud. Our client won on both the civil fraud and on the criminal fraud in Bailey II (pdf).
Agreement voided ab initio for fraud with referral to Bureau of Fraud Prevention for possible criminal proceedings.
Mohr v. Shivani Inc. (pdf) - The parties entered an Agreement on an unwitnessed accident. A cash advance company later contacted us to assert a lien on compensation in violation of Delaware's law. Our investigation into the cash advance company brought to light that the Claimant had admittedly injured herself at home. We asked the I.A.B. to enjoin the cash advance company and successfully voided the entire Agreement for fraud.
Full indemnity to Insurer ordered based on an Employer's compensation fraud against Claimant and premium fraud.
Skinner v. Barbutes (pdf) - A complete description of the peculiar facts of this case is found under the "Coverage Denial" section above.
Industrial Accident Board limits claim to thirteen days and extinguishes all future liability.
Walker v. Castle Ride Transp. (pdf) - Claimant was involved in an auto accident so minor that he admitted to the hospital he was uninjured. Three days later his attorney set up an appointment with a workmen's compensation doctor. While driving to that appointment, he was involved in another accident. He claimed everything arose from the first accident and sought $102,502.59 in compensation. We showed he regularly treated for these complaints since 1998. The I.A.B. awarded him a total of $619.05 and held that everything resolved so there is no future liability.
Industrial Accident Board finds 0% impairment and extinguishes all future liability.
Patille v. Del-Mar-Va Staff'g (pdf) - The parties previously entered into three separate Agreements for a limited amount of medical benefits for reflex sympathetic dystrophy to the right hand while stating that any "RSD fully resolved." Over a year later, Claimant demanded 30% permanent impairment to her right hand. We argued that she had 0% impairment as if the accident never occurred; pointing out that her complaints of "excruciating" pain in her right hand were contradicted by her driving stick shift to the hearing. The I.A.B. agreed, denied the petition and extinguished all future liability.
Employer hires one of Claimant's treating physicians as an expert for finding that all injuries resolved.
Cannedy v. GEM Ambulance (pdf) - Claimant alleged ongoing injury to her knee after a "lifting incident." We argued any injury was short lived and resolved so that she returned to her baseline normal status as she was prior to accident. We retained one of her treating providers. The I.A.B. ruled she made a complete recovery and ended future liability.
ALL DISABILITY TERMINATED:
I.A.B. finds Claimant returned to pre-accident status post surgery and terminates compensation without FCE.
Sweetman v. Willis Chevrolet (pdf) - Claimant had a pre-existing injury to his lumbar spine which caused pain rated at 4/10 prior to the industrial accident with our client. After sustaining new injury to the same area, he underwent two surgeries over two years but refused to return to work. We proved that his pain was now the same, or better, than prior to the accident when he had worked full time. The I.A.B. also held that a Functional Capacity Evaluation is not mandatory in Delaware to prove return to full duty work without restriction.
I.A.B. finds injuries resolved to deny lumbar surgery.
Goodchild v. R&E Excavation (pdf) - The Claimant (a CDL driver) sought lumbar hardware removal surgery and ongoing total disability. We argued that everything from the accident resolved so he returned to his pre-existing baseline back pain and that he voluntarily retired by seeking a handicapped license plate. The I.A.B. agreed and denied the claim.
DISABILITY TERMINATED & INJURY DENIED:
I.A.B. terminates total disability and denies Claimant's request to add shoulder injury to parties' Agreement.
Maggio v. Robin Drive Auto (pdf) - The parties previously entered into an Agreement to accept a neck injury and place Claimant on total disability. After finding Facebook posts of Claimant working, we petitioned the I.A.B. to review the Agreement to terminate total disability. Claimant responded by also petitioning the I.A.B. to review the Agreement to add a shoulder injury. Our client won on all counts: Termination was granted, there was no entitlement to temporary partial disability and the I.A.B. rejected the shoulder claim.
INCOMPLETE STATEMENT OF FACTS:
Claimant's failure to provide complete answers on a Statement of Facts leads to dismissal of claim.
Bryan v. L.B. Cleaning Servs. II (pdf) - A Claimant sought recognition of a knee injury and surgery from an industrial accident with our client, an uninsured employer. The Claimant initially provided extremely sparse information on the Statement of Facts filed with his petition, which led Mr. Andrews to file a motion with the I.A.B. to compel complete answers on a new Statement of Facts, which Claimant was to sign. The I.A.B. ordered such in Bryan v. L.B. Cleaning Servs. I (pdf). Although he provided updated answers to comply with the order, his answers remained evasive. After a hearing on the merits, the I.A.B. denied Claimant's petition, dismissed our client for not having employed Claimant and excoriated Claimant for his tactics by holding, "Any claimed harm to Claimant... is Claimant's own fault. If Claimant had been a little more forthcoming as to the factual nature of his claim, this entire hearing might have been avoided."
TESTIMONY STRICKEN ON FAILURE TO PRODUCE:
I.A.B. strikes Claimant's testimony due to his failure to provide complete responses to Employer's discovery request.
Maggio v. Robin Drive Auto (pdf) - A complete description of the peculiar facts of this case is found under the "Liability Extinguished" section above.
FALSE FIRST REPORT OF INJURY:
Claimants are prohibited to file First Reports of Injury to make a claim before the Industrial Accident Board.
Soriano v. Natural House (pdf) - A Claimant petitioned the I.A.B. on January 27, 2016 after he was allegedly injured by an industrial accident on October 9, 2015. His ability to file the petition was based on a document in the I.A.B.'s file that purported to be "Employer's" First Report of Injury. In reality, Employer was unaware of any injury or accident until the day he received the petition; otherwise, he would have provided medical care for his employee. Discovery showed that the Claimant's attorney had filed the false report as though he was the Employer in order to file a claim. The I.A.B. expunged the false report, allowed Employer to file a true one and perpetually enjoined the Claimant and his attorney from ever filing such reports again as only employers may file them. As this also proved that Employer had no notice for over 90 days from the accident, most liability was extinguished.
TWO-YEAR DEADLINE TO FILE CLAIM:
Claims for personal injury are extinguished if a petition is not filed within two years of accident.
Flagg v. Leeber Ltd. U.S.A. (pdf) - The Claimant initially filed a petition for injuries to his knees that he claimed were the result of an industrial accident on April 27, 2015. He then withdrew his petition only to refile the petition on April 27, 2017. We argued that the refiled petition missed the two-year deadline in which to file the petition by one day. We also argued that 19 Del. C. § 2361(a) was technically a "statute of repose" and not a "statute of limitations" so that the two-year deadline could not be waived and no savings statute could apply. The Industrial Accident Board agreed and dismissed the petition with prejudice.
CONTESTED COMMUTATION PAID TO TRUST WITH REVERSIONARY INTEREST TO EMPLOYER:
Employer successfully commutes all future liability at present value and pay lump sum to trust with reversionary interest.
R & J Construction v. Vidal (pdf) - The Claimant sustained many injuries for which the parties entered into an I.A.B. Agreement. As time progressed, the Employer and Insurer retained our firm to decrease their ongoing exposures in this case. Our solution was to utilize a section of the law that had last been used in 1922. We filed for a contested commutation whose lump sum, after discounted to present value, would be paid to a trust instead of to Claimant. The I.A.B. agreed. Our strategy decreased our clients' costs by $493,630.18 and any amount that remains after claimant's death shall revert back to the Insurer.
PERPETUAL INJUNCTION AGAINST CASH ADVANCE LAWSUIT LOAN COMPANY:
Industrial Accident Board perpetually enjoins lawsuit loan company from all further business in the State of Delaware.
Shivani Inc. v. Global Financial Credit (pdf) - The Claimant and her attorney executed an illegal Cash Advance Agreement ("CAA") with Global Financial whereby it would front the costs for Claimant to retain her attorney in return for a cut of whatever money she received. After showing that the entire claim was a fraud in Mohr v. Shivani Inc. (pdf), we petitioned the I.A.B. for a perpetual injunction to prohibit Global Financial from conducting any further business in the State. Four months later Global Financial violated the injunction against another of our clients. Returning to the I.A.B., we had them sanctioned, ordered to pay our firm $10,704.80 in costs, ordered to shut down all operations in Delaware and ordered to notify all claimants from 2002 to present that Global Financial has no right to recover in Wendover Inc. v. Global Financial Credit (pdf). If they violate this order, they shall automatically be held in contempt, fined $250,000.00 and placed into receivership.
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