In Moran v. Rouse’s Enterprises, LLC, 19-2392019(La. App.5
Cir. 12/26/19)- – – So. 3d – – -, the Louisiana Fifth Circuit held that there
is a forfeiture of all benefits when a worker’s compensation claimant commits
fraud, regardless of when the fraudulent conduct occurs. The court declined to
follow opinions from the First and Third Circuits concluding otherwise.
In Moran, the claimant obtained treatment for injuries to
her back, right knee, and right shoulder after a slip and fall at work for
Rouses supermarket. In her deposition, the claimant Moran testified that she
experienced knee pain only once before her fall; it was “years ago” and not
“serious.” Moran also claimed that she experienced no prior shoulder or back
pain. However, medical records established:
• Complaints
of knee pain on at least 8 separate occasions between 2012 and the job injury;
• Complaints
of right knee, right wrist, and back pain after a slip and fall in 2013; and
• A right
shoulder impingement diagnosis 2 months before the on-the-job accident.
Rouses and its workers compensation carrier affirmatively
alleged a violation of La. R.S. 23:1208, Louisiana’s workers compensation fraud
statute, following the claimant’s deposition. Paragraphs “A” and “E” of section
1208 provide in pertinent part:
A. It shall
be unlawful for any person… to willfully make a false statement or
representation… for the purpose of obtaining or defeating any benefit or
payment under…this Chapter.
***
E. Any
employee violating this Section shall… forfeit any right to compensation
benefits under this Chapter.
As part of their fraud defense, the defendants specifically
denied responsibility for all worker’s compensation benefits, i.e. benefits
that that might have otherwise been due both before and after the fraudulent
deposition testimony.
Following trial, the workers compensation judge determined
that Moran carried her burden of proving the occurrence of on-the-job injury
and disability. Nevertheless, the trial court also ruled that the claimant made
false statements for the purpose of obtaining workers compensation benefits in
violation of section 1208, thereby forfeiting the right to both the pre and
post-deposition benefits that she was claiming.
On appeal, Moran argued that the forfeiture requirement of
section 1208 applies prospectively only. Moran cited opinions from the
Louisiana First and Third Circuits. After addressing the statute and the case
law, the Moran court affirmed the decision of the workers compensation judge
finding that the forfeiture of benefits provided for in of Section 1208 is
clear and unambiguous. The opinion states that “…if the legislature had
intended to limit the application … it would have clearly expressed that in the
statute.”
There are no Louisiana Supreme Court opinions which specifically address whether the Section 1208 forfeiture applies retroactively or prospectively only. Given the defined split in the Louisiana appellate courts, the issue is ripe for consideration by the state’s highest court.
Ed is a Keogh Cox partner who litigates Worker’s Compensation, automobile and premises liability as well as subrogation claims. He is an avid runner and enjoys traveling with his wife Jennifer and their three children.
