Dukes v. Sherwood Acres Apartments

835 So. 2d 742, 2002 WL 31667619
CourtLouisiana Court of Appeal
DecidedNovember 8, 2002
Docket2001 CA 2325
StatusPublished
Cited by8 cases

This text of 835 So. 2d 742 (Dukes v. Sherwood Acres Apartments) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dukes v. Sherwood Acres Apartments, 835 So. 2d 742, 2002 WL 31667619 (La. Ct. App. 2002).

Opinion

835 So.2d 742 (2002)

Wayne DUKES
v.
SHERWOOD ACRES APARTMENTS and Fireman's Fund Insurance Company.

No. 2001 CA 2325.

Court of Appeal of Louisiana, First Circuit.

November 8, 2002.

*744 Terry L. Bonnie, Baton Rouge, Counsel for Plaintiff/Appellant Wayne Dukes.

M. Blake Monrose, Lafayette, Counsel for Defendants/Appellees Sherwood Acres Apartments and Fireman's Fund Insurance Co.

Before: KUHN, DOWNING, and GAIDRY, JJ.

KUHN, J.

Claimant-appellant, Wayne Dukes, appeals a judgment in favor of employer-appellee, Sherwood Acres Apartments (Sherwood Acres) and its compensation insurer-appellee, Fireman's Fund Insurance Company, on their reconventional demand, finding that Dukes willfully made false statements and/or representations for the purpose of obtaining workers' compensation benefits. Declaring forfeiture of Dukes' right to past, present, or future workers' compensation, the judgment also orders Dukes to pay a $5,000.00 civil penalty and $16,248.94 in restitution as well as an additional $12,060.32 for investigation and litigation costs.[1] We affirm in part, vacate in part, and remand with instructions.

FACTUAL AND PROCEDURAL BACKGROUND

On May 5, 2000, while employed as a maintenance person at Sherwood Acres, Dukes allegedly injured his lower back while reinstalling a toilet in an apartment bathroom. He notified his supervisor and the Sherwood Acres office manager. At his employer's suggestion, Dukes sought medical attention at Summit Hospital. An x-ray was taken, which revealed chronic degenerative findings, with no detection of acute trauma to the lumbar spine. The treating physician at Summit Hospital indicated his impression of Dukes's condition based on the x-ray was a lumbar strain. He was given medical prescriptions and advised to apply heat to his lower back. Four days later, Dukes sought additional medical attention from his personal physician, Dr. Raynando Banks, for lower back pain. Dr. Banks referred Dukes to Dr. Boyd for epidural injections. And Dr. Boyd apparently placed Dukes on a regimen of physical therapy after two epidural injections failed to relieve the lower back pain. Dukes was also seen by Dr. Lea at the request of appellees.

A request for an evaluation by a surgeon was apparently pending when Dukes filed a disputed claim form (1008) seeking his choice of physician as well as penalties and attorney's fees. Appellees answered Dukes' allegations and filed a reconventional demand, averring that by willfully making false statements and/or representations in order to obtain workers' compensation benefits, Dukes forfeited any *745 right to workers' compensation benefits. Appellees requested full statutory recovery from Dukes.

After a hearing on the merits, the Workers' Compensation Judge (WCJ) determined that appellees were entitled to relief on their reconventional demand. The WCJ signed a judgment declaring that Dukes forfeited his right to workers' compensation benefits, assessed a $5,000.00 civil penalty, and ordered restitution. Dukes appeals.

DISCUSSION

Louisiana Revised Statute 23:1208 provides in relevant part:

A. It shall be unlawful for any person, for the purpose of obtaining or defeating any benefit or payment under the provisions of this Chapter, either for himself or for any other person, to willfully make a false statement or representation.
* * *
C. (1) Whoever violates any provision of this Section, when the benefits claimed or payments obtained have a value of ten thousand dollars or more, shall be imprisoned, with or without hard labor, for not more than ten years, or fined not more than ten thousand dollars, or both.
(2) Whoever violates any provision of this Section, when the benefits claimed or payments obtained have a value of two thousand five hundred dollars or more, but less than a value of ten thousand dollars shall be imprisoned, with or without hard labor, for not more than five years, or fined not more than five thousand dollars, or both.
(3) Whoever violates any provision of this Section, when the benefits claimed or payments obtained have a value of less than two thousand five hundred dollars, shall be imprisoned for not more than six months or fined not more than five hundred dollars, or both.
(4) Notwithstanding any provision of law to the contrary which defines "benefits claimed or payments obtained", for purposes of Subsection C of this Section, the definition of "benefits claimed or payments obtained" shall include the cost or value of indemnity benefits, and the cost or value of health care, medical case management, vocational rehabilitation, transportation expense, and the reasonable costs of investigation and litigation.
D. In addition to the criminal penalties provided for in Subsection C of this Section, any person violating the provisions of this Section may be assessed civil penalties by the workers' compensation judge of not less than five hundred dollars nor more than five thousand dollars, and may be ordered to make restitution. Restitution may only be ordered for benefits claimed or payments obtained through fraud and only up to the time the employer became aware of the fraudulent conduct.
E. Any employee violating this Section shall, upon determination by workers' compensation judge, forfeit any right to compensation benefits under this Chapter.

The only requirements for forfeiture of benefits under section 1208 are that: (1) there is a false statement or representation, (2) it is willfully made, and (3) it is made for the purpose of obtaining or defeating any benefit or payment. Hull v. Fluker Farms, 00-0757, p. 6 (La.App. 1st Cir.5/11/01), 787 So.2d 535, 539.

The issue of whether an employee forfeited his workers' compensation benefits is one of fact, which is not to be reversed on appeal, absent manifest error. *746 Id. Before an appellate court may reverse the factual determinations of the WCJ, it must find from the record a reasonable factual basis does not exist for the findings, i.e., that the findings are clearly wrong or manifestly erroneous. Id. Where two permissible views of the evidence exist, the factfinder's choice between them cannot be manifestly erroneous or clearly wrong. Id., 00-0757 at p. 6, 737 So.2d at 539-40 (citing Stobart v. State, Dep't of Transp. and Dev., 617 So.2d 880, 883 (La.1993)).

Dukes urges the WCJ was manifestly erroneous in its conclusion that he willfully made false statements or representations. Dukes suggests that careful scrutiny of his deposition testimony, taken on December 21, 2000, and his testimony at the hearing on the merits on April 18, 2001, fails to reveal any false statements or representations to support the imposition of relief under La. R.S. 23:1208 in favor of appellees.

At the hearing on the merits, appellees introduced the medical records of Dukes' treating physician, Dr. Banks. According to Dr. Banks' records, on February 24, 2000, Dukes sought medical attention for pain in his lower back and knees. Dr. Banks' handwritten notation on the February 24, 2000, Progress Note states that Dukes reported, "he is almost paralyzed." There is no history provided in the "Chief Complaint with History" section of the February 24, 2000, Progress Note. Dr. Banks' records also include a Progress Note for May 9, 2000, which expressly states that Dukes complained of "having injury on job," indicating that the patient's chief complaints were neck and back pain.

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Bluebook (online)
835 So. 2d 742, 2002 WL 31667619, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dukes-v-sherwood-acres-apartments-lactapp-2002.