Hayes v. Industrial Enterprises, Inc.

809 So. 2d 319, 2000 La.App. 1 Cir. 1472, 2001 La. App. LEXIS 2089, 2001 WL 1144128
CourtLouisiana Court of Appeal
DecidedSeptember 28, 2001
DocketNo. 2000 CA 1472
StatusPublished

This text of 809 So. 2d 319 (Hayes v. Industrial Enterprises, Inc.) 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
Hayes v. Industrial Enterprises, Inc., 809 So. 2d 319, 2000 La.App. 1 Cir. 1472, 2001 La. App. LEXIS 2089, 2001 WL 1144128 (La. Ct. App. 2001).

Opinion

| .CARTER, C.J.

This is an appeal from a decision by a workers’ compensation judge that plaintiff, Talmadge Hayes, forfeited his entitlement to workers’ compensation benefits pursuant to LSA-R.S. 23:1208. In accordance with this decision, the workers’ compensation judge rendered judgment dismissing plaintiffs claim for workers’ compensation benefits with prejudice.

FACTUAL BACKGROUND

Plaintiff began working for defendant, Industrial Enterprises, Inc., on January 26, 1999,2 as a handyman. On June 9, plaintiff allegedly injured his lower back and right hip and leg when he lifted a length of pipe. Plaintiff reported the accident the next morning to Pat Wheat, defendant’s employee in charge of human resources. Ms. Wheat sent plaintiff to the Healthsouth Medical Clinic (Healthsouth) for treatment. On June 10, Dr. Jonathan Roundtree at Healthsouth diagnosed plaintiff with right hip strain and released him to return to light duty. Plaintiff returned to work on June 11, but left after working about half of the day because of continued complaints of pain. After June 11, plaintiff never returned to work with defendant.

Plaintiff was treated at Healthsouth on a couple more occasions before seeking treatment from Dr. Richie R. Roth and Dr. Thomas Plantz, chiropractors at the Family Chiropractic Clinic. Drs. Roth and Plantz certified that plaintiff was disabled [321]*321from June 28 through July 28. Plaintiff continued to seek treatment at the Family Chiropractic Clinic through August 5.

Beginning in mid-June, plaintiff sought treatment at the Earl K. Long Medical Center emergency room and walk-in clinic. On June 19, Dr. W. Phillip Mitchell examined plaintiff in the emergency room for complaints of buttock pain. Dr. Mitchell listed “[h]erniated Lumbar L4-L5 Disc” as the final diagnosis on the June 19 medical record. Subsequent visits by plaintiff to the emergency room and walk-in clinic with complaints of back pain and chronic right hip and leg pain resulted in diagnoses of lumbar disk disease. In August, a MRI was performed on plaintiff, which confirmed that | ¿plaintiff suffered from a herniated disk at the L4-5 level. In November 1999, plaintiffs attorney referred him to see Dr. Jack F. Loupe, an orthopedic surgeon. Dr. Loupe diagnosed plaintiff with a herniated disk at the L4-5 level. Based on plaintiffs assertion that he did not have any prior problems with his lower back, Dr. Loupe opined that plaintiff sustained a disabling back injury on June 9.

PROCEDURAL HISTORY

On July 15, 1999, plaintiff filed a disputed claim for compensation, alleging injury to his lower back and right leg.3 Defendant filed an answer denying 1) that either an accident or injury occurred in the course and scope of plaintiffs employment, 2) that plaintiff sustained a work-related disability, and 3) that plaintiff was entitled to workers’ compensation benefits. After a trial, the workers’ compensation judge decided that while an on-the-job injury-exacerbated a pre-existing injury to his lower back and right hip and leg, plaintiffs failure to disclose the existence of preexisting back and right leg and hip conditions to defendant required the dismissal of his claim. A judgment was signed dismissing plaintiffs claim with prejudice at his costs. Plaintiff appeals, asserting that the trial court was manifestly erroneous 1) in ordering a forfeiture of benefits and 2) in not awarding workers’ compensation benefits, penalties and attorney fees.

FORFEITURE OF BENEFITS

Louisiana Revised Statute 23:1208 provides in pertinent part as follows:

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.
[[Image here]]
E. Any employee violating this Section shall, upon determination by workers’ compensation judge, forfeit any right to compensation benefits under this Chapter.

This section was intended to prevent and discourage fraud in relation to workers’ compensation claims. Section 1208 clearly applies to any willful false statements or representations made “for the purpose of obtaining or defeating any benefit or Inpayment.” Resweber v. Haroil Construction Company, 94-2708, p. 7 (La.9/5/95), 660 So.2d 7, 12. Such false representations, made to anyone, including the employer, physicians or insurers, result in forfeiture of those workers’ compensation benefits when the representations are made willfully or deliberately for the purpose of obtaining benefits. Resweber, 660 [322]*322So.2d at 9; Varnado v. Winn-Dixie Louisiana, Inc., 98-0301, p. 9 (La.App. 1st Cir.9/25/98), 720 So.2d 66, 70. Thus, 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. Resweber, 660 So.2d at 12.

A workers’ compensation judge’s determination that the requirements of Section 1208 were met may not be set aside unless the determination is clearly wrong or manifestly erroneous in light of the record reviewed in its entirety. See Martin v. Olsten Industrial Services, 98-0463, p. 3 (La.9/18/98), 718 So.2d 404, 406; Cole v. Drainage District No. 9 of Parish of Jefferson, 99-1411, p. 3 (La.App. 5th Cir.4/25/00), 760 So.2d 529, 531.

It is clear from the record that up to and through the hearing, plaintiff routinely denied any prior back problems or right leg and hip problems prior to the alleged June 9 accident. During his treatment at the Family Chiropractic Clinic, plaintiff completed and signed a patient information form on June 23 in which he denied receiving treatment “by a physician for any health condition in the last year.” He also faded to mark “backaches” as being “relevant to his medical history” on the patient information form. However, on an “Accidental Injury Report” provided by the Family Chiropractic Clinic, plaintiff marked that he had had “similar accidents or injuries before,” but did not elaborate on the prior injuries or accidents. Yet, the only medical history given to Drs. Roth and Plantz was a past history of heart murmurs and a motor vehicle accident in the 1980’s that had “resolved.”

In September 1999, plaintiff answered interrogatories propounded by defendant wherein he denied any “pre-existing disability or disease prior to this accident.” Plaintiff also stated that he “had no other accidental injuries, diseases, disabilities, physical defects, or abnormalities of any nature.” In the medical history given to Dr. Loupe, | ¡¡plaintiff also denied any previous back problems or disabilities, although he stated that he was treated at Earl K Long for left leg problems. At the hearing, plaintiff consistently denied any back or right hip or leg pain or problems before the June 9 accident.

Contrary to the assertions made by plaintiff to his treating physicians, in his answers to interrogatories and at the hearing, the Earl K. Long medical records pertaining to plaintiff revealed that plaintiff was treated for right leg and hip pain and lower back pain on March 29, 1999, and that diagnostic testing performed in April 1999 revealed a herniated disk at the L4-5 level.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Martin v. Olsten Indus. Services
718 So. 2d 404 (Supreme Court of Louisiana, 1998)
Bass v. Allen Cannery Co., Inc.
715 So. 2d 142 (Louisiana Court of Appeal, 1998)
Varnado v. Winn-Dixie Louisiana, Inc.
720 So. 2d 66 (Louisiana Court of Appeal, 1998)
Resweber v. Haroil Const. Co.
660 So. 2d 7 (Supreme Court of Louisiana, 1995)
Cole v. Drainage District No. 9
760 So. 2d 529 (Louisiana Court of Appeal, 2000)

Cite This Page — Counsel Stack

Bluebook (online)
809 So. 2d 319, 2000 La.App. 1 Cir. 1472, 2001 La. App. LEXIS 2089, 2001 WL 1144128, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hayes-v-industrial-enterprises-inc-lactapp-2001.