Surveillance Proves Fraud

Claimant alleged that he sustained a work related injury when he slipped and fell at his job, thereby aggravating a prior injury to his back.  Benefits were initially paid to Claimant for his injury, however, further investigation demonstrated Claimant made false statements to his treating physician.  Benefits were therefore terminated, and the dispute was brought before the workers’ compensation judge.  The judge found that Claimant deliberately  made false statements in order to obtain workers’ compensation benefits, and that he therefore forfeited his right to these benefits.  Claimant appealed this decision.

The appellate court first noted that false representations must be made for the purpose of obtaining benefits and must be more than inadvertent or inconsequential statements.  The fraud statute set forth in La. R.S. 23:1208 applies to statements made to insurance investigators and to physicians, and does not require any showing of employer prejudice.

The workers’ compensation judge’s decision was affirmed by the appellate court.  Claimant complained to his  doctor that he was experiencing pain at a “ten out of ten” level, and that his pain increased with sitting, standing, walking, driving, riding in a vehicle, and with flexion or extension.  Surveillance video, however, painted a much different picture of Claimant’s physical capabilities.  Video footage showed Claimant, just eleven days after rating his pain as ten out of ten, walking, bending, and crouching while rolling up an “inflatable fun jump”.  He showed no signs of pain or discomfort; rather, Claimant was smiling and laughing while casually engaging in conversation.  Upon review of the footage, Dr. Douglas Bernard testified that someone in the pain Claimant claimed could not have performed the activity on the surveillance footage.

A decision to impose or deny forfeiture under La. R.S. 23:1208 is a factual finding that is not disturbed on appeal absent manifest error.  The appellate court found that the evidence in the record supported the workers’ compensation judge’s decision and affirmed.

Hypolite v. Louisiana Workers’ Compensation Corp.