Louisiana Court Finds Injured Worker Made False Representations to Receive Benefits, Forfeited Right to Workers’ Compensation Benefits

forfeit benefits

In a recent case before the Louisiana Third Circuit Court of Appeal, the court reviewed a case in which the workers’ compensation judge found the claimant had made willful misstatements for the purpose of obtaining Louisiana workers’ compensation benefits.  In this case, the court stated the level of proof necessary to show an injured worker’s false representations are more than inadvertent statements. In this case, medical testimony and surveillance video showed that the injured worker had in fact made false statements in order to receive benefits.scales

In April 2012, Earnest Hypolite suffered a workplace accident when he slipped and fell during work at the M.A. Patout sugar mill. He aggravated a previous back injury.  His employer paid indemnity and medical benefits through their workers’ compensation insurer.  The insurer then terminated the benefits after investigating Mr. Hypolite’s claim and concluding that he made false statements to his treating physician and that he had been collecting income from a personal business.

A trial took place, and the workers’ compensation judge held that Mr. Hypolite violated Louisiana law by making false statements.  The judge held he had therefore forfeited his right to workers’ compensation benefits. Mr. Hypolite appealed.

On appeal, the court addressed Mr. Hypolite’s allegation that the judge erred in finding that the insurer proved he had committed fraud.  To prove fraud, the claimant must have made a false statement, willfully, for the purpose of obtaining workers’ compensation benefits.  Louisiana law requires that a false representation be more than inadvertent statements.

The court stated that to deny or forfeit benefits is a factual finding, and to disturb a decision on appeal requires a showing of manifest error.  To reverse a determination, the court asks whether the record has a reasonable factual basis for the finding of the trier of fact, and whether the record shows the finding is clearly wrong. The question is whether the fact finder’s conclusion was reasonable.

Here, the court stated there was no error in the workers’ compensation judge’s finding that Mr. Hypolite deliberately made false statements to his treating doctor in order to receive workers’ compensation benefits.

In May 2012, Mr. Hypolite complained of severe pain in his back, and he stated that his leg pain increased while sitting, standing, or driving. But the complaints were contradicted by surveillance video obtained by the workers’ compensation insurer.  He was seen walking and driving without discomfort.

And days after stating he could not tolerate walking, he was caught on film bending over, walking, and crouching.  In multiple videos, he was found to be comfortable moving around, displaying no discomfort.  The court of appeal stated these surveillance videos by themselves showed that Mr. Hypolite’s statements to his doctor were not truthful.

Furthermore, the testimony of Mr. Hypolite’s doctor made clear that someone in the pain Mr. Hypolite alleged he suffered could not have performed the actions seen on surveillance camera.  The appellate court stated there was no manifest error in the workers’ compensation judge’s findings. The statements Mr. Hypolite made to his doctor were willful, made for the purpose of obtaining benefits under the Louisiana workers’ compensation system.  This supported the workers’ compensation judge’s finding.

At Lavis Law, individuals injured in the course and scope of their employment can better understand their rights under Louisiana workers’ compensation law. We help injured workers and their loved ones pursue compensation for work-related injuries. Contact our office for a free consultation at 866-855-9151.

More Blog Posts:

Louisiana Appellate Court Affirms Finding that Injured Airplane Mechanic Offered Credible Testimony of His Work-Related Accident and Suffered Compensable Injury, Louisiana Insurance & Injury Lawyer Blog

Appellate Court in Louisiana Holds Injured Employee Had Not Committed Fraud in Effort to Obtain Workers’ Compensation, Louisiana Insurance & Injury Lawyer Blog

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