Prior Injury and Workers' Comp: What You Must Disclose

Every workers’ compensation claim form in New York asks the same uncomfortable question: have you ever injured this part of your body before? Injured workers answer it in a hurry, in pain, often in a second language, and the answer follows them for the life of the claim. Get it wrong on purpose and Workers’ Compensation Law 114-a can strip the benefits and, in the worst cases, bar you from wage benefits forever. Get it wrong by accident and the carrier will still try.

On September 3, 2026, the Appellate Division, Third Department, decided Matter of Loja-Saula v Cosan Construction Corp., and it is the clearest recent statement of where the line sits. A bricklayer kept his benefits despite two insurance-database reports that the carrier said proved he had hidden prior injuries. This is what the case holds, what the statute actually requires, and how to answer the prior-injury question so it never becomes the case.

What Section 114-a says

The statute is short. A claimant who, “for the purpose of obtaining workers’ compensation benefits, knowingly makes a false statement or representation as to a material fact shall be disqualified from receiving any compensation directly attributable to such false statement or representation.” That mandatory penalty takes away the benefits tied to the lie. On top of it, the Board may impose a discretionary penalty, up to a permanent bar on future wage-replacement benefits, where the misconduct was serious enough.

Three points from the cases the Third Department cited in Loja-Saula:

• An omission counts. The court repeated that “an omission of material information may constitute a knowing false statement or misrepresentation.” Leaving the prior-injury box blank, or answering “no” when the answer was “yes, 2019, same shoulder,” is the classic 114-a case.
• Materiality is broad. A fact is material if it could affect the claim: a prior injury to the same site, a prior claim, a subsequent job you did not mention, physical activities inconsistent with your claimed disability. Prior injuries to the same body part are material almost by definition, because they go to whether the work accident caused the condition.
• “Knowingly” is the fight. The carrier has to prove the claimant knew the statement was false when made. That is a factual and credibility question, and “whether a claimant has violated the statute lies within the province of the Board, which is the sole arbiter of witness credibility.”

What happened in Loja-Saula

Luis Loja-Saula, a bricklayer, was hurt on April 15, 2022, when a piece of a concrete cinderblock fell on him. A workers’ compensation law judge established the claim for his head, left shoulder and back, and the Board later added the neck, left wrist and left knee.

The carrier then alleged that he had failed to disclose prior injuries to those sites on his C-3 claim form. Its proof was two Insurance Services Office reports, the database searches carriers run on every claimant. The first, searched by name, produced three matches; two had slightly different names and different addresses from the only address the claimant had ever had in this country, and the third showed a 2017 motor vehicle accident with an unspecified injury. The second, searched by a Social Security number the carrier attributed to him, produced thirteen matches: two were plainly the April 15, 2022 work injury itself, recorded under a liability policy and a comp policy, and the other eleven were personal auto claims from 1999 to 2014 by people with different birth dates and addresses. The carrier added an arbitration report about a pharmacy suing an insurer over prescriptions for someone with the claimant’s name after a car accident on, of all dates, April 15, 2022.

The claimant testified that he was not in a car accident that day, that he had been in one in 2021 but could not recall the accidents in the reports or any claims from them, that he did not recall injuring the body parts at issue before the cinderblock, that he had no Social Security number and had never given one to anyone, and that he never got medication from that pharmacy.

The law judge found a violation, disqualified him from the benefits attributable to it, and permanently barred future wage benefits. The Board rescinded that decision for insufficient proof, and on September 3, 2026 the Third Department affirmed the Board. Its reasoning: the reports were riddled with inconsistencies about whether the people in them were the claimant at all; the two matches that did identify him could be his own work injury rather than a car accident; and nothing verified that the person in the pharmacy report was him. Because the Board is the fact-finder and “the mere fact that there may be evidence in the record to support contrary conclusions is of no moment,” the decision stood.

What the case teaches, in both directions

For claimants. A database match is not proof. ISO ClaimSearch and similar services match on names, addresses and identifiers, and common names, shared addresses, transposed digits and identity confusion produce false hits constantly. When a carrier raises 114-a on the strength of a printout, the response is to go match by match: whose address, whose birth date, whose claim, what injury, and whether the “prior” claim is actually the current one recorded twice. The Board in Loja-Saula did exactly that.

Also for claimants. The bricklayer won because his testimony was credible and the carrier’s proof was bad. He did not win because omissions are harmless. Had the carrier produced a prior comp claim in his name, at his address, for his left shoulder, with medical records, the omission on the C-3 would have been a knowing false statement and the mandatory penalty would have followed. The case is a warning about the quality of proof carriers bring, not a license to leave the box blank.

For carriers and employers. The Third Department will not second-guess the Board’s credibility findings, so a 114-a case has to be built with evidence that identifies the claimant beyond a database hit: certified prior claim files, medical records, deposition testimony, surveillance where activities contradict the claimed disability. A report with eleven strangers in it is not that.

How to answer the prior-injury question

Disclose more than you think you need to. Every prior injury, claim, surgery or treatment to the body parts in the claim, whether it was a car accident, a sports injury, a previous job, or an old comp case. The statute punishes concealment, not a bad medical history. A prior injury does not defeat a claim; New York compensates aggravation of pre-existing conditions, and the carrier’s remedy for a prior condition is an apportionment argument at the medical stage, not a fraud finding.

If you cannot remember, say so. “I had a back strain some years ago, I do not recall the date or the provider” is not a false statement. “No” when you had a lumbar MRI in 2019 is.

Correct mistakes yourself, first. If you realize after filing that you left something out, tell your lawyer and put the correction on the record at the next hearing. The Board treats a voluntary correction very differently from an omission the carrier exposes.

Know that the search happens on every claim. Carriers run ISO on intake as a matter of routine. Assume they will find every claim you ever filed, and remember, as Loja-Saula shows, that they will also find claims you never filed and have to be made to prove which is which.

Keep your testimony consistent. The C-3, the medical intake forms, the independent medical examination history, and your hearing testimony are all compared. The common 114-a case is not a single lie; it is a claimant who told each doctor a slightly different story.

Where this fits with the rest of a comp case

The disclosure issue is one piece of a claim that also has to establish the accident, the injury sites, the degree of disability and the wage rate. Our guides on how to win your workers’ comp fight and on car accidents while working, where a prior-injury question comes up in both the comp claim and the third-party case, cover those stages. The workers’ compensation practice page explains how we handle claims and 114-a defenses across Nassau and Suffolk.

FAQ

Do I have to disclose a prior injury on my New York workers’ comp claim? Yes, if it is to a body part involved in the claim, and it is safer to disclose any prior injury or claim at all. Workers’ Compensation Law 114-a treats a knowing omission of a material fact as a false statement.

Will a prior injury make me lose my claim? No. New York compensates work injuries that aggravate a pre-existing condition. A prior injury affects apportionment and medical causation, not eligibility. Hiding it is what causes the loss.

What is the penalty under Section 114-a? Mandatory: disqualification from the compensation directly attributable to the false statement. Discretionary: an additional penalty up to a permanent bar on future wage-replacement benefits, in cases the Board finds egregious.

What did Matter of Loja-Saula decide? On September 3, 2026, the Third Department affirmed the Board’s finding that two ISO database reports full of mismatched names, addresses and birth dates, plus an unverified pharmacy arbitration report, did not prove the claimant knowingly concealed prior injuries. The Board’s credibility findings control when supported by substantial evidence.

What is an ISO report? A search of an industry claims database (ISO ClaimSearch) by name, address or identifier. Carriers run it on every claimant. Matches can be wrong, as Loja-Saula shows, and each one has to be tied to the claimant with real proof.

I forgot a prior injury on my C-3. What should I do? Correct it immediately, on the record, through your lawyer. A voluntary correction before the carrier raises the issue is the strongest answer to a later 114-a allegation.

Does 114-a apply to statements to doctors? Yes. Statements to treating doctors, to the carrier’s independent medical examiner, and at hearings are all statements “for the purpose of obtaining” benefits. Consistency across all of them is the point.

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The carrier’s database will find every claim with your name on it, including the ones that are not yours. Disclose what is yours, dispute what is not, and the statute written to catch liars has nothing to catch.

Call 516-750-0595 or request a free case review if a carrier has raised Section 114-a against your claim.