In a recent workers’ compensation appellate decision from the Louisiana Third Circuit, the employee-claimants’ false statements about drug use, medical history, and medical treatment did not rise to the level of fraud or misrepresentation to preclude recovery of significant workers’ compensation benefits.
Raney v. Top Deck, Inc.
In Raney v. Top Deck, Inc., (No. 18-0927) the claimant alleged that he sustained work-related injury resulting from an explosion that occurred at the employer’s facility in DeRidder, Louisiana. Employer denied the claim on the basis that Claimant was not in the course and scope of his employment. At trial, the workers’ compensation judge found that Claimant had met his burden of proof in finding that an accident occurred and awarded benefits.
One of several issues that Employer appealed was the workers’ compensation judge’s rejection of the fraud defense pursuant to Louisiana Revised Statutes, 23:1208 based on Claimant’s intentional misrepresentation of his medical history and substance abuse issues in order to obtain disability determinations and medical benefits to which he was not entitled. Employer contended that, while a substance abuse problems does not in and of itself defeat a disability claim, Claimant lied to his physicians about his opioid use to obtain additional medications and willfully violated his treating physicians’ opioid policies. Additionally, Claimant lied to his orthopedic surgeons about his prior orthopedic medical history in an effort to relate his disability to his work accident.
Ultimately, the workers’ compensation judge refused to find that Claimant made a willfully false statement for the purpose of obtaining benefits, and the Third Circuit found that finding not to be manifestly erroneous.