In a recent opinion, the Louisiana Third Circuit addressed an employer’s contention that an employee committed fraud for the purpose of obtaining workers’ compensation benefits. Louisiana law precludes an employee from recovering benefits when a false statement or misrepresentation has been made in order to receive benefits. In this appeal, the court addressed the workers’ compensation judge’s finding that the employee was credible, as well as other proceedings before the court, in order to determine whether the judgment in favor of the employee had been manifest error. Margaret Gaines worked for Pinecrest Support and Services Center as a residential services specialist. Pinecrest is a state institution that provides treatment for intellectually and developmentally disabled adults. Ms. Gaines claimed that she suffered work-related injuries when administering to the needs of clients. She asserted injuries to her shoulder and back. Months later, Ms. Gaines filed a disputed claim for compensation, penalties, and attorney fees on the ground that Pinecrest failed to pay her indemnity benefits. Pinecrest answered, denying Ms. Gaines’ right to compensation and asserting an offset under Louisiana law if the workers’ compensation judge should rule in her favor. Then, Pinecrest amended their answer to allege that Ms. Gaines committed fraud when she asked a coworker to lie about a second accident.
In a recent appeal, the Louisiana Third Circuit Court of Appeal reversed an award of medical benefits in a workers’ compensation case in which the employer argued that intoxication was the cause of an employee’s workplace accident. Louisiana workers’ compensation law holds that an employee is barred from recovering benefits when intoxication caused the workplace injury. Timothy Schouest worked for Acadian Construction Services (“Acadian”) in the role of field working supervisor. Mr. Schouest began a job on March 24, 2014 at ExPert Riser in Fourchon. That evening, Mr. Schouest drank alcohol and smoked one marijuana joint. On the next morning at 6:00 a.m., Mr. Schouest began constructing a paint booth along with Justin Bell, who was assisting him. Mr. Bell left the job site after an argument, and Mr. Schouest continued construction himself. He was injured while installing a 30-pound panel. While he was attempting to attach the panel to beams, it slid and severely cut his right hand. On appeal, the court addressed Mr. Schouest’s contention that he was not intoxicated at the time of his injury. His two arguments were that his accident took place 12 hours after smoking a marijuana cigarette, and because he regularly smokes marijuana his drug test results were elevated.
Recently, the Louisiana Second Circuit Court of Appeal addressed a damages award in a personal injury lawsuit following a fight outside a restaurant. The plaintiff, who underwent surgery following the incident, argued that the jury did not award him enough damages for his medical costs and lost wages from work. On appeal, the court noted that the jury had to assess whether a preexisting condition contributed to the plaintiff’s need for surgery, and whether the jury’s award was clearly wrong. Benjamin Baw, a Monroe, Louisiana Police Officer, and Norman Paulson began to fight in the parking lot of Trio’s Restaurant in Monroe, Louisiana. Mr. Baw was dating Mr. Paulson’s ex-girlfriend, and Mr. Paulson had called her a name and then hit her and knocked her into a vehicle in the parking lot. As Mr. Baw attempted to restrain Mr. Paulson, he was punched in the right eye. The Trio’s bartender broke up the fight, and Mr. Baw was treated for injuries sustained during the fight. Mr. Baw underwent surgery for his lumbar disc. Mr. Baw then brought a personal injury lawsuit against Mr. Paulson.
In a recent opinion, the Louisiana Third Circuit Court of Appeal held that an injured employee forfeited his right to workers’ compensation when he consistently misrepresented or omitted medical evidence of his history and condition. The court upheld the finding of the lower court that he had made intentional misrepresentations to his employer and that these were made for the purpose of obtaining benefits. Todd Romero worked for the Wood Group as an operator and maintained satellite oil well platforms in Black Bay, Louisiana. After being transported by crew boat from headquarters to a well, Mr. Romero alleged he stepped off the boat and onto a platform, twisting his left ankle. There were no witnesses, and his version of events was challenged by a co-worker. Mr. Romero was diagnosed with a sprained ankle and treated, and then he underwent an independent medical examination after two surgical procedures. Wood Group discovered that before the incident on the platform, Mr. Romero had hurt the same ankle years earlier while working for Action Oilfield Services. He had received workers’ compensation benefits and missed work for approximately seven months due to this earlier incident. This earlier work-related ankle surgery had not been disclosed to the employer by Mr. Romero.