The Louisiana Court of Appeal for the Third Circuit recently affirmed a workers’ compensation judge’s decision to terminate workers’ compensation benefits based upon fraud by the injured worker. In Hypolite v. Louisiana Workers’ Compensation Corp., 2016-387 (La. App. 3 Cir. 11/2/16), 2016 WL 6496578, the workers’ compensation insurer terminated benefits based upon numerous false statements made by the claimant to his doctor during medical treatment for the injuries sustained in a work accident.
La. R.S. 23:1208 makes it “unlawful for any person, for the purpose of obtaining or defeating any benefit or payment under the provision of this Chapter, either for himself or for any other person, to willfully make a false statement or representation.” Among the remedies available against an employee who violates the statute is forfeiture of workers’ compensation benefits. To establish “§1208 fraud,” the employer/insurer must prove that: 1) the claimant made a false statement or representation; 2) the statement or representation was willfully made; and, 3) the statement or representation was made for the purpose of obtaining workers’ compensation benefits. However, false statements “must be more than inadvertent or inconsequential statements.”
In Hypolite, the workers’ compensation judge found, and the appellate court agreed, that sufficient evidence was presented during the five-day workers’ compensation trial to establish that the claimant deliberately made false statements in order to receive workers’ compensation benefits. Alleging an aggravation of a low back injury, the plaintiff told his physician that he felt increased pain when “sitting, standing, walking, driving or riding in a vehicle, flexion, and extension” and rated his pain as a 10/10. However, surveillance video presented by the insurer showed the claimant walking, driving, bending, crouching, dancing, and performing other physical activities without any signs of discomfort. Further, at trial, an expert physician viewed the video and testified that an injured person with the back complaints voiced by the claimant could not physically have been able to perform the walking, jumping, dancing, etc. depicted in the video.
Based upon the evidence presented at trial, the claimant was found to have committed §1208 fraud which forfeited his right to workers’ compensation benefits.