On January 5, 2017, the Louisiana Court of Appeals for the First Circuit (“First Circuit”) reviewed several holdings by the Office of Workers’ Compensation Administration (“OWCA”), considering several assignments of error presented by both the employee and employer. The dispute arose from an incident on September 11, 2013 when the employee fell from a height of eight to fourteen feet onto a steel rig floor, injuring his back and head. The employer paid workers’ compensation benefits from the date of the accident until March 13, 2014. The following day, the employer filed a disputed claim for compensation against the employee.
One issue presented was whether the OWCA properly found that the September 11, 2013 incident caused a head laceration and soft tissue muscular injury but did not cause a fracture at the employee’s T-12 level vertebrae. The First Circuit affirmed the OWCA’s conclusion, which considered the fact that the employee was in eleven accidents from 1995 through 2013, excluding the September 11, 2013 accident. Two of those accidents were work-related and the remaining eight were motor vehicle accidents. The employee had reported back pain, among other issues, following eight of his prior accidents. In a 2005 accident, the employee fell and injured his neck and back and sustained a compression fracture of the T-12 vertebrae. On March 13, 2013, he was in a motor vehicle accident requiring subsequent medical treatment through July 23, 2013, after which he complained of back pain and settled for $10,000 less than two weeks after the September 11, 2013 accident. Because of the proximity in time of the March 2013 and September 2013 accidents, the presumption of causation, which is appropriate if the employee’s symptoms do not manifest before a subject accident. The First Circuit found no manifest error in the OWCA’s decision on the issue.
The First Circuit was also presented with a review of whether the employee violated La. R.S. 23:1208, which provides that an employee who makes a false statement for the purpose of obtaining workers’ compensation benefits shall forfeit any right to compensation benefits. The burden of proof requires more than a mere showing of inconsistent statements or inadvertent admissions by the employee. There must be a showing that a misrepresentation was willfully made for the purpose of obtaining benefits. In the matter before it, the OWCA determined that the employee did not violate La. R.S. 23:1208 when he earned $1,355.09 selling 15,132 units of scrap metal after the subject accident through July 25, 2014. Due to the employee’s intellectual level, he had limited ability to read and write, and his failure to understand what activities were prohibited under the statute, he did not engage in willful false representation to obtain workers’ compensation benefits when he sold scrap metal. The First Circuit affirmed this ruling despite the fact that the employee gave a false statement in his deposition as to whether or not he was selling scrap metal. The question then became whether the employee made the statement “for the purpose of obtaining or defeating any benefit of payment.” La. R.S. 23:1208(G) requires, upon reasonable request, an employee to report his other earnings to his employer’s payor on a form prescribed by the director and signed by the employee if the employee receives benefits for more than thirty days. In the present case, the employee did submit such a report as requested on October 16, 2013. The form, however, provided in part that “[a]s an injured worker, you must notify your employer or insurer of the earnings of any wages,….” The First Circuit looked to the dictionary to determine that a wage is a payment for services. The sale of scrap metal, therefore, did not constitute a wage and the employee did not violate La. R.S. 23:1208 because the form the employee signed speaks in terms of reporting wages and La. R.S. 23:1208 speaks in terms of reporting earnings, which the dictionary defines as the sale of goods. The First Circuit held that the inconsistency created ambiguity and confusion and therefore affirmed the OWCA’s decision on the issue.
Also presenting a question under La. R.S. 23:1208 was whether the employee violated the statute in presenting an incomplete medical history after the subject accident to one or more medical providers. The OWCA found that he did not misrepresent his medical history because he suffered trauma after the September 11, 2013 accident and because his treating physician had the employee’s medical records. Furthermore, the physician testified that he generally reviewed a patient’s medical history after examining the patient and noted in his initial report that the employee had been in nine prior accidents, so he was aware of the employee’s prior medical history.
Although faced with several other assignments of error, the First Circuit affirmed the OWCA’s decisions on all accounts. The matter highlights a scenario where attempting to confuse the issue of medical causation, whether to establish or refute same, may be more black and white. There is value in dissecting an employee’s medical history with a scalpel, highlighting the exact treatment and its proximity to an accident or other treatment that may win or lose a case for your client. As is often preached in the legal profession: details, details, details. In another manner, it was the details that were determinative in whether the employee had violated La. R.S. 23:1208. The language of the relevant form filled out by the employee, containing the term “wages” as opposed to “earnings”, and the plain meanings of the terms therein were the difference between a finding of the employee’s violation or obedience to the statute.
Guichard Operating Company, LLC v. Porche