Freeman v. Triad Builders

902 So. 2d 1220, 2005 WL 1109582
CourtLouisiana Court of Appeal
DecidedMay 11, 2005
Docket39,657-WCA
StatusPublished
Cited by10 cases

This text of 902 So. 2d 1220 (Freeman v. Triad Builders) 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
Freeman v. Triad Builders, 902 So. 2d 1220, 2005 WL 1109582 (La. Ct. App. 2005).

Opinion

902 So.2d 1220 (2005)

Walter FREEMAN, Plaintiff-Appellee
v.
TRIAD BUILDERS and CNA Insurance Companies, Defendants-Appellants.

No. 39,657-WCA.

Court of Appeal of Louisiana, Second Circuit.

May 11, 2005.

*1222 Mayer, Smith & Roberts, L.L.P., by Kim Purdy Thomas, Shreveport, for Appellants.

Law Office of William T. Allison, LLC, by William T. Allison, Shreveport, for Appellee.

Before WILLIAMS, STEWART & PEATROSS, JJ.

PEATROSS, J.

This workers' compensation action arises out of claimant's, Walter Freeman, 1995 accident and injury during the course and scope of his employment as a carpenter with Triad Builders ("Triad"). Triad and its workers' compensation carrier, CNA Insurance Companies ("CNA"), appeal the workers' compensation judge's ("WCJ") ruling that Mr. Freeman did not willfully make false representations for the purpose of obtaining benefits under La. R.S. 23:1208. For the reasons stated herein, we affirm in part and reverse in part.

FACTS AND ACTION OF THE WCJ

Mr. Freeman injured his back on the job in 1995 and Triad and CNA began paying benefits and providing medical treatment. Mr. Freeman underwent three surgical procedures and received extensive pain management therapy for severe back and leg pain. Mr. Freeman asserts that the third surgery relieved the leg pain, but the back pain persisted unabated. During 1996 and 1997, Mr. Freeman's pain management included numerous steroid injections and very high doses and quantities of opiate pain medication. Also during this time, CNA denied some of Mr. Freeman's claims for pain management therapy, including narcotics; and, when he requested a trial of acupuncture, CNA denied the claim. Mr. Freeman filed several disputed claim forms due to CNA's various denials for pain management treatment — in December 2000, after filing a disputed claim form seeking a trial of acupuncture, a hearing was held wherein the WCJ ordered production of reports from the pain management physicians who had treated Mr. Freeman. Following review of those reports, CNA agreed to pay for the acupuncture *1223 trial. Mr. Freeman asserts that the acupuncture treatments reduced his pain considerably.

In the interim, CNA began surveillance of Mr. Freeman to investigate his activity and capabilities. Two videotapes were obtained showing Mr. Freeman and his wife traveling from their home in Choudrant to Shreveport to the acupuncturist's office. The videotapes show the Freemans exiting the office after the treatments and getting into their vehicle with Mrs. Freeman driving. A few minutes later, the two pull over and switch places with Mr. Freeman taking over the driving. Triad and CNA argue that Mr. Freeman can be seen on the tapes bending over and generally acting as if he is pain-free. The second videotape shows a similar scenario, wherein the couple leaves the office with Mrs. Freeman driving initially, but stopping a few blocks from the office and switching places. The tapes also show the couple going to Wal-Mart and Auto Zone.

Approximately two months after the tapes were made, Mr. Freeman was deposed. In his deposition, he testified that he could not drive far from his home and that he only drove 100 yards or so to his father's home from his home. He stated that he could not drive due to the large amounts of pain medication he was having to take and he could not recall having driven home from Shreveport after his appointments a couple of months earlier. According to Triad and CNA, Mr. Freeman also told one of his physicians, Dr. Osborne, that he was unable to drive farther than the 100-yard distance to his father's house.

After Mr. Freeman's deposition, Triad terminated benefits and refused further medical treatment. Mr. Freeman filed another disputed claim form and Triad pled the affirmative defense of fraud under La. R.S. 23:1208. The parties stipulated that the only issue to be tried was the alleged 23:1208 violation.[1]

After trial, the WCJ found that, while Mr. Freeman did make a misstatement, it was neither material nor willful, and that the insurer's use of 23:1208 was technical and overzealous. He concluded that Mr. Freeman had been "terribly" affected by the persistent use of narcotic pain medications. He further concluded that "neither Resweber [infra] nor Louisiana Statutes 23:1208 was intended to bar legitimate claimants who inadvertently give contradictory statements after years of pain, depression, and the effects of prescribed medication, from receiving the compensation benefits to which they are entitled." The judgment provided for restoration of indemnity payments and reinstatement of medical benefits. In addition, the judge awarded Mr. Freeman attorney fees in the amount of $5,000. Mr. Freeman filed a motion for new trial on the issue of attorney fees and the record was supplemented with medical records. Ultimately, judgment was entered maintaining the dismissal of the 23:1208 fraud defense and the restoration of benefits retroactive to September 9, 2001, and related medicals, and further increasing the award of attorney fees to Mr. Freeman to $15,000.

Regarding the increase in attorney fees, we note that Triad pointed out to the WCJ that the judgment on the 1208 issue should have been limited only to a 1208 determination as it was the only question at issue — not attorney fees. For this reason, there was a subsequent judgment, *1224 wherein the attorney fee award was increased to $15,000 — the judge clarified that he was not awarding attorney fees for matters raised in this case under a different docket number, but that were never consolidated with the present fraud claim, namely, the request for Triad to pay for a trial of acupuncture therapy. He did, however, emphasize that he believed the insurance company was uncaring and not compassionate with Mr. Freeman and that he was unimpressed with the video surveillance conducted by CNA. He then noted the novelty of the issue involved and the fact that this matter had been prepared for hearing several times. For these reasons, the WCJ increased the original attorney fee award of $5,000 to $15,000.

DISCUSSION

Triad and CNA assert the following two assignments of error on appeal (verbatim):

1. The hearing officer was clearly wrong, manifestly erroneous and erred in finding that the claimant did not commit a violation of La. R.S. 23:1208 by willfully making a false representation to secure benefits under the Worker's Compensation Act such that his rights to benefits should be forfeited.
2. The hearing officer was clearly wrong, manifestly erroneous and erred in finding that the defendant did not have a reasonable basis for the discontinuation of benefits and the award of attorney's fees associated therewith should be reversed.

Fraud — La.R.S. 23:1208

La. R.S. 23:1208 provides, in pertinent part:

1208. Misrepresentations concerning benefit payments; penalty
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.
* * *

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Bluebook (online)
902 So. 2d 1220, 2005 WL 1109582, Counsel Stack Legal Research, https://law.counselstack.com/opinion/freeman-v-triad-builders-lactapp-2005.