BROOKLYN, N.Y. (Legal Newsline) - New York personal injury lawyers are caught in a lawsuit alleging they conspired with health care providers to exaggerate claims in pursuit of "windfall" recoveries in the tort system.
Treatment of alleged injuries for Spanish-speaking construction workers is at the heart of a March 1 lawsuit in New York federal court by Roosevelt Road, a reinsurance company, and insurer Tradesman Program Managers, alleging they have been forced to pay much more than they should have because crooked doctors are padding clients' bills.
Construction accident law firm Gorayeb & Associates and Workers' Comp firm Fogelgaren Forman & Bergman are among dozens of defendants in the case accused of racketeering.
Tradesman says it has lost more than $1 million from the alleged scheme, while Roosevelt claims much more.
"Defendants' submission of false medical records in order to support their fraudulent claim constitutes a sufficient basis for criminal indictment in the State of New York," the lawsuit says.
Tradesman noticed Workers' Comp payouts increasing in 2020, plus more tort claims alleging workplace violations as the cause of injuries, the suit says. The Gorayeb law firm had been providing OSHA training courses in Spanish led by an unlicensed instructor to "preemptively and unlawfully solicit new clients" in violation of New York law, it adds. The instructor handed out his phone number and reminded attendees Gorayeb does not charge for a consultation.
The seminars were sponsored by Sisa Pakari Cultural Center and created a pipeline for claimants who were taught how to act following an alleged injury to maximize recovery, the suit says.
The instructor is alleged to offered to bring lunch to job sites if workers sent him a picture of themselves so he could gain access.
In 2022, the class was taught to leave work in an ambulance so the boss "cannot deny that the accident happened on the job." They were also told workers can sue the owners of the building where they are allegedly hurt and the general contractor, in addition to pursuing Workers' Comp claims against their employer.
New York's long-standing and controversial Scaffold Law would help their cases, attendees were told. It imposes absolute liability for property owners and contractors, meaning the claimant can't be found to have been at any percentage of fault.
Such OSHA seminars are considered "grooming" by the plaintiffs. Sisa Pakari has provided advertising and steered clients to Gorayeb in exchange for payments, the suit claims.
The plaintiffs looked at four claimants unnamed in the lawsuit who were said to be sent to emergency rooms or urgent care facilities but were discharged with no evidence of serious injury.
"Rather than being the end of it, all Claimants were quickly steered to (Fogelgaren Forman & Bergman) and Medical Provider Defendants within days, typically NY Ortho or CitiMed, whose personnel quickly diagnosed a host of alleged injuries and claimed all were causally related the alleged incident," the suit says.
The plaintiffs include the affidavits of doctors who reviewed and disagreed with their diagnoses and treatments. Radiographic imaging would uncover disc herniations and bulges that led to physical therapy.
"The physical therapy medical records are overwhelmingly generic to the extent that they largely fail to document what body part was supposedly being treated, how they are being treated, diagnoses and prognosis," the suit says.
On these four claimants alone, Roosevelt Road says it lost somewhere between $6 million and $12 million. Michael Graves of The Willis Law Group represents the plaintiffs.