Article ID: 3e339953693d18fc9d56a566e40959954c67eb70e3f8b28d9fc5b6ded4506958
Source ID: secondary:businessinsurance.com
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URL: https://www.businessinsurance.com/new-york-court-rejects-comp-fraud-claim-based-on-database-reports/
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New York court rejects comp fraud claim based on database reports - Business Insurance Skip to content Register for free Search Search Log In Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2026 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2026 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2026 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2026 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers New York court rejects comp fraud claim based on database reports Workers Comp Coverage , Workplace Safety Sep 3, 2026 A New York appeals court on Thursday upheld a Workers’ Compensation Board ruling that a construction worker did not commit benefits fraud by failing to disclose alleged prior injuries, finding that insurance database reports did not reliably establish that the earlier claims belonged to him. In Matter of Loja-Saula v. Cosan Construction Corp. , the Appellate Division of the New York Supreme Court, Third Department, affirmed the board’s decision to rescind penalties imposed against Luis Loja-Saula. Mr. Loja-Saula, a bricklayer, sought workers compensation benefits after a piece of concrete cinderblock fell on him in April 2022. His claim was established for injuries to his head, left shoulder and back and later expanded to include his neck, left wrist and left knee. Cosan Construction Corp. and its insurer alleged that Mr. Loja-Saula failed to disclose previous injuries involving the body parts listed on his claim form. A workers compensation law judge found that he had violated state law, disqualified him from benefits attributable to the violation and permanently barred him from receiving future wage-replacement benefits. The board reversed, finding insufficient evidence of a violation. The employer and insurer relied on two Insurance Services Office reports listing earlier insurance claims allegedly filed by Mr. Loja-Saula. Most of the database matches involved people with different names, addresses or birth dates, according to the ruling. Two matches containing Mr. Loja-Saula’s correct identifying information appeared to concern the same April 2022 workplace accident underlying his compensation claim. The court said there was also no evidence confirming that a person identified by name in a separate pharmacy arbitration report was Mr. Loja-Saula. Mr. Loja-Saula testified that he did not have a Social Security number and did not recall the accidents or injuries described in the reports. The appellate court said the board is responsible for resolving factual and credibility questions and that its finding of insufficient proof was supported by substantial evidence. 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