Opinion ID: 199579
Heading Depth: 2
Heading Rank: 1

Heading: Formoso's Deceit

Text: 5 Three months after the Victory Button Company accident, Milan began a course of treatment for his injury. His prognosis at that time was poor, with at least one of his doctors indicating that Milan would suffer a total disability unless and until surgery was performed. That surgery never occurred. Indeed, Milan's doctors were unanimous in concluding that he had suffered a disabling injury that prevented him, at least temporarily, from returning to work. These doctors, however, were apparently never told that during the same period that they concluded he could not work, Milan was working, as Formoso, at the Westford Regency Hotel as a dishwasher. 2 Moreover, Formoso took another job at Malu Construction in the fall of 1989, again while still under a diagnosis of disability from his doctors. Thus, during the time when Milan was diagnosed as totally disabled, Formoso was in fact performing two other jobs. In other words, the injury to Milan, though serious enough to keep Milan from working, had no corresponding effect on Formoso's ability to work. 6 Indeed, Formoso apparently only lost his ability to work when he suffered an accident as Formoso at the Westford Regency Hotel. Nonetheless, there was a basis in the evidence for questioning whether that accident actually resulted in any injury. Dr. Robert Bates, a chiropractor, treated Milan from August 10, 1989, to April 6, 1990, three times a week. Though this time period included the Westford Regency Hotel accident on November 17, 1989--and therefore should have included some loss of function corresponding to that injury--Dr. Bates testified that Milan showed a fairly consistent improvement in condition. There were . . . waxes and waning of symptoms, in other words, be a little better, a little worse; but overall he got a little bit better through the treatment. 7 Moreover, Dr. Bates put Milan through a series of circuit training exercises designed to improve muscle strength in his back. Dr. Bates kept logs of these exercises. These logs showed that between November 17 and December 4, 1989, and again between December 4, 1989 and February 2, 1990, Milan increased the weights he used on these machines as well as the number of repetitions he performed. In contrast, during the same period, Formoso was seen by Dr. Param Singh (on November 28, 1989), Dr. Roland Caron (on December 29, 1989) and Dr. Bernard Stone (on February 28, 1990). Dr. Singh reported that Formoso was experiencing low back pain that was moderate to severe in intensity, constant in nature, aggravated by movements of the spine, by prolonged ambulation, prolonged standing, or any physical exertion. Dr. Caron saw surgery as an option and opined that Formoso is totally disabled at the present time with a guarded prognosis. Dr. Stone confirmed the reports of low back pain and recommended surgery as a realistic option because Formoso's symptoms were not improving. Dr. Bates, however, considered Milan's progress on the circuit training exercises from November 17, 1989 to February 2, 1990, as indicative of a positive result. 8 This evidence reveals a striking disjunction during the same time frame between Milan's improving conditions and Formoso's supposedly severe back problem. Indeed, the medical histories of Milan and Formoso are like those of two different people. When Milan suffered a debilitating injury, Milan needed to stop work while Formoso kept working. Likewise, when Formoso fell at the hotel, he exhibited severe symptoms while Milan showed steady progress in his rehabilitation. It is undisputed, however, that Milan and Formoso are the same person. What reconciles the contradictions is a scheme to defraud St. Paul. Before the accident at the hotel, Formoso knew--from his treatment as Milan--that the objective indicators of injury, such as x-rays, would be consistent with a lower back injury like the one he had already suffered at the Victory Button Company. 3 He knew the symptoms the doctors would expect from that injury. To fabricate a claim for workers' compensation benefits he only needed an accident at the hotel that he could claim resulted in symptoms identical to those he was already experiencing because of his prior injury. He could then convince doctors that there was a causal connection between his symptoms and that accident by claiming to have no prior back injuries. Whether the accident at the hotel was a mere fortuity or was manufactured makes no difference. The jury could have concluded that Formoso recognized his opportunity and, using the symptoms from his Victory Button Company injury, proceeded to claim benefits from St. Paul despite the absence of any actual injury during the fall at the hotel.