Claimant fell and injured her back while in the course and scope of her employment with Employer. The workers’ compensation judge awarded Claimant benefits for her injury, and Employer appealed.
Employer claims that the workers’ compensation judge erred in failing to find that Claimant forfeited her workers’ compensation benefits due to her willful misstatements and representations over the lifespan of her claim. Employer maintained that Claimant’s deposition testimony and trial testimony were riddled with inconsistencies that warranted forfeiture of benefits.
Under the Louisiana workers’ compensation statute, an injured worker may forfeit the benefits to which they are entitled if they willfully make a false statement or misrepresentation for the purpose of obtaining payment. Forfeiture is a harsh remedy, and Employer is burdened with proving each element within the statute. The lack of any one of the elements is fatal to an employer’s avoidance of liability.
Employer argued that Claimant was not forthcoming about her previous neck and back issues. When asked if back surgery had ever been recommended in the past, Claimant stated it had not. Records, however, revealed that the doctor who performed Claimant’s prior neck surgery had also suggested back surgery. Claimant explained that the focus of the treatment was her neck, and that her back issues were tolerable. Claimant never denied the neck surgery, nor did she deny that she had back problems prior to the incident.
Additionally, Employer argued that Claimant made material misrepresentations about her post-injury earnings. Claimant spoke with staff in her attorney’s office about whether she could work at a bingo parlor. The staff advised her that she could do so as long as it was in her work restrictions, but failed to inform her of the requirements to report her earnings. Employer maintained that failure to report these post-injury wages constituted a misrepresentation.
The appellate court found that although there were certainly some discrepancies in Claimant’s testimony, there was nothing of significance that would justify forfeiture of benefits. The appellate court therefore affirmed the workers’ compensation judge’s ruling, finding that there was no manifest error in the ruling that Employer failed to establish that benefits should be forfeited.
Rachal v. Wal-Mart Corporation