Louisiana Claimant Gets Hit With Forfeiture of Benefits and Stiff Penalties for Misrepresentations

A Louisiana appellate court has affirmed an Order of the state’s Office of Workers’ Compensation that heavily sanctioned a workers’ compensation claimant for fraud in violation of La. R. S. 23:1208 [Borders v. Boggs & Poole Contracting Group, Inc., 49,228 (La.App. 2 Cir. 08/13/14); 2014 La. App. LEXIS 1963]. The OWC’s Order dismissed the worker’s demand for benefits, required that the worker repay all benefits paid through a certain date, as well as all costs of litigation, and further ordered the worker to pay $1,000 to the Kids Chance Scholarship Fund, a fund specified in the state’s workers’ compensation fraud statute.

In its appellate opinion, the court noted that the statute authorized forfeiture of benefits upon proof that (1) there was a false statement or representation; (2) it was willfully made; and, (3) it was made for the purpose of obtaining or defeating any benefit or payment. The court further noted that because statutory forfeiture of benefits is a harsh remedy, it must be strictly construed. Finding that the defendants clearly met their burden, the court noted that the claimant failed to offer any evidence in support of his claims for benefits. Although claimant repeatedly insisted that a doctor told him he had a “cracked kneecap” due to his accident, he presented no evidence, other than his “dubious testimony,” to show that anything was medically wrong with him. The court indicated that when claimant presented at the hospital for his knee pain several days after the accident, X-ray of the knee were negative for fracture. Furthermore, an MRI of his knee was essentially normal. When the defendants’ physician offered a second medical opinion, opining that claimant exhibited “marked emotional magnification of symptoms and findings,” claimant, who had appeared pro se, insisted that the OWC investigate the doctor.

The court indicated the WCJ’s findings were detailed, that surveillance video showed claimant performing a host of activities that were inconsistent with his alleged condition, that he lifted a heavy boat battery, single-handedly carried a small boat from the back of his truck, fished for several hours, and then reloaded the boat. The OWC found claimant not to be credible, indicating that while claimant said he could not drive, he nevertheless drove off in his own vehicle when the trial recessed for lunch. Claimant repeatedly burst into tears in the courtroom, only to recover immediately upon going outside. Claimant acknowledged that he used his cane “primarily when he sees his doctors or his lawyer, or when he comes to court.” “It seems his injuries likewise surface only when necessary to support his claim,” the WCJ added.

Credibility was for the WCJ to determine, concluded the court. The findings were not “manifestly erroneous or clearly wrong.”