Workers’ Compensation Panel Reverses Claim Denial for Man With Two Names

By | May 19, 2023
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A Virginia man who was denied workers’ compensation benefits for his workplace injury because he apparently used two different names is entitled to have his name on the record corrected and his claim reconsidered, the Virginia Workers’ Compensation Commission (WCC) has ruled.

In March 2023, the claimant filed a claim for medical and wage loss benefits alleging that he sustained a compensable injury by accident to his right shoulder. At the time, he advised that his name was “Oscar A. Rodriguez a/k/a Jose Munoz Morales.”

The employer and insurer maintained that the claim was in the name of the employee, Jose Munoz Morales. They presented a medical record reflecting treatment rendered for “Jose Munoz Morales,” an identification card with the name “Jose D Munoz Morales,” and a social security card containing the name “Jose Daniel Munoz Morales.”

The insurer also said it had received two different permanent resident cards for the claimant. The cards had the same picture, but not the same country of origin, residence, or expiration date. One of the cards was from medical records received and copied by the healthcare provider, while the other card was from the employer.

Also, the employer noted that while the claimant’s lawyer at first gave his client’s name as Oscar A. Rodriguez a/k/a Jose Munoz Morales, during discovery the lawyer used only Jose Munoz Morales.

The insurer determined that while the claimant “may possibly be Oscar A. Rodriquez, as he alleges, he is clearly not Jose Munoz-Morales,” the name under which he filed the claim. Thus the insurer denied the claim.

The claimant requested that the WCC modify the case record to reflect his actual name and identity to be Oscar A. Rodriguez. He argued that his actual name did not negate the fact that he was injured while working as an employee of the employer.

The insurer opposed amending the record as an “inappropriate response to a false and misleading filing.”

A WCC deputy commissioner considered the case and dismissed the pending claim with prejudice. The deputy commissioner found “significant that the claimant’s response to the defendants’ motion confirms that the claimant’s name is not ‘Munoz-Morales'” and held that an award of benefits should not be awarded to an incorrectly identified individual.

The worker appealed to a WCC panel of three commissioners. These commissioners reversed and vacated the deputy’s ruling, disagreeing with the dismissal with prejudice at this preliminary stage.

The WCC panel agreed that benefits should not be awarded to an incorrectly identified claimant but noted that the claimant clarified his correct identity prior to a hearing. The WCC appeals panel also found it important that the claimant is in the preliminary process of pursuing his claim.

“We find dismissing with finality the claimant’s claim at this preliminary stage is too harsh of a sanction based upon the underlying facts of this particular case,” the opinion concludes. “A dismissal with prejudice barring the refiling of a claim should enter only in cases where there has been an abuse of process or deliberate disregard for the Commission’s authority.”

The panel ordered that the record of the case be modified to show that injured employee’s name is Oscar A. Rodriquez. It added that this reversal does not prevent the employer from raising any defenses in correlation to the claimant’s identity.

Topics Workers' Compensation Talent

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