Massingill v. Dunham Price Group, L.L.C.

38 So. 3d 498, 9 La.App. 3 Cir. 1549, 2010 La. App. LEXIS 647, 2010 WL 1779993
CourtLouisiana Court of Appeal
DecidedMay 5, 2010
Docket09-1549
StatusPublished
Cited by1 cases

This text of 38 So. 3d 498 (Massingill v. Dunham Price Group, L.L.C.) 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
Massingill v. Dunham Price Group, L.L.C., 38 So. 3d 498, 9 La.App. 3 Cir. 1549, 2010 La. App. LEXIS 647, 2010 WL 1779993 (La. Ct. App. 2010).

Opinion

AMY, Judge.

hThe claimant brought suit against his employer seeking indemnity benefits, medical treatment, penalties, and attorney fees. The defendant contended that the claimant was not entitled to benefits based upon the fraud defenses in La. R.S. 23:1208 and La. R.S. 23:1208.1. The workers’ compensation judge found in favor of the claimant and awarded him benefits, penalties, and attorney fees. The defendant appeals. The claimant answers the appeal, seeking additional attorney fees for defending the appeal. For the following reasons, we affirm and award additional attorney fees for work performed on appeal.

Factual and Procedural Background

According to the stipulations entered into between the parties, the claimant, Billy Jo Massingill, was in an accident during the course and scope of employment with *501 the defendant, Dunham Price, when he fell nine feet from the hood of a front end loader. The claimant sustained injuries, requiring him to undergo nose surgery and have several teeth replaced. The defendant provided for those procedures. After the procedures were completed, the claimant worked for the defendant for several months before quitting his job. He complained of ongoing head and neck pain and scheduled an appointment with an orthopedic surgeon. The claimant was evaluated by Dr. Clark Gunderson, an orthopedist, who issued a no-work restriction and diagnosed the claimant with a cervical strain. Further, Dr. Gunderson sought authorization for surgery, specifically, for an anteri- or cervical fusion of the claimant’s C3-4 and C4-5 with anterior plate and bone growth stimulator. 1 After this no-work restriction was 12issued, the defendant issued temporary total disability benefits but denied authorization for surgery.

On March 15, 2007, the claimant filed a Disputed Claim for Compensation seeking indemnity benefits, questioning the average weekly wage and indemnity computations, and seeking vocational rehabilitation services and other medical authorizations. The claimant also requested penalties and attorney fees. The defendant responded to the claim, alleging that the benefits sought by the claimant were forfeited under La. R.S. 23:1208 and La. R.S. 23:1208.1. Specifically, the defendant argued that the claimant made multiple misrepresentations about prior medical conditions. Further, the defendant argued that the claimant was not entitled to surgery, penalties, or attorney fees. The workers’ compensation judge appointed Dr. Lynn Foret as an independent medical examiner to opine as to whether surgery was appropriate.

After a full hearing on the merits, the workers’ compensation judge denied the defendant’s fraud defenses and awarded benefits, surgery, penalties and attorney fees, and costs and interest to the claimant.

The defendant appeals, asserting that the workers’ compensation judge erred in: (1) denying the defense under La. R.S. 23:1208 and/or La. R.S. 23:1208.1; (2) awarding penalties and attorney fees in light of the fraud defenses; (3) awarding surgery; (4) awarding supplemental earnings benefits (SEBs); (5) assessing penalties pertaining to the SEBs award, the vocational rehabilitation award, the discography, the medical bill payments, the psychological treatment modalities, the initial installment of temporary total disability benefits; and (6) the quantum of attorney fees. The claimant has answered the appeal, seeking additional attorney fees.

| .¡Discussion

La. R.S. 23:1208

The defendant first argues that the trial court erred in denying its defense under La. R.S. 23:1208 in light of the claimant’s alleged false statements in his deposition, medical reports, and trial testimony.

Louisiana Revised Statutes 23:1208 provides the parameters for determining whether a claimant has committed fraud for the purpose of obtaining workers’ compensation benefits. Campbell v. City of Leesville, 07-1061 (La.App. 3 Cir. 1/30/08), 974 So.2d 908, writ denied, 08-491 (La.4/25/08), 978 So.2d 366. It provides in pertinent part:

§ 1208. Misrepresentations concerning benefit payments; penalty
*502 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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E. Any employee violating this Section shall, upon determination by workers’ compensation judge, forfeit any right to compensation benefits under this Chapter.

In Resweber v. Haroil Constr. Co., 94-2708, p. 7 (La.9/5/95), 660 So.2d 7, 12, the supreme court provided that an employer claiming an employee has forfeited his or her rights under La. R.S. 23:1208 must prove “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.” It further explained:

The statute does not require the forfeiture of benefits for any false statement, but rather only false statements that are willfully made for the purpose of obtaining benefits. It is evident that the relationship between the false statement and the pending claim will be probative in determining whether the statement was made willfully for the purpose |4of obtaining benefits. Clearly, an inadvertent and inconsequential false statement would not result in forfeiture of benefits.

Id. at 17.

In her oral reasons for judgment, the workers’ compensation judge stated:

In this case, there is some inconsistencies [sic] made by [the claimant]. However, considering [the claimant’s] limited mental abilities, the considerable injuries suffered; i.e., falling nine feet head first on the ground, being knocked unconscious from the blow thus suffering the brain injury, then working for nearly a year after the incident does not present to the court one who is willfully making false representations for the purpose of obtaining workers’ compensation benefits.

The defendant argues, in brief, that the workers’ compensation judge’s “reasoning in finding that the misrepresentations were not willfull based upon the claimant’s limited mental abilities was in error” and that the workers’ compensation judge erred in reasoning “that the misrepresentations by the claimant were not willful based upon the nature of the accident.” It asserts that the medical records demonstrate that the claimant was capable of describing his accident and medical history. The defendant cites several examples wherein it alleges that the claimant presented to doctors and denied having previous problems with his neck, back, and nose, while the evidence demonstrated to the contrary. Further, it cites the reports of two doctors who examined the claimant, Dr. Darren Strother, clinical neuropsychol-ogist, and Dr. Rennie Culver, neuropsychi-atrist, who opined that the claimant was exaggerating and malingering.

In workers’ compensation cases, factual findings are subject to the manifest error or clearly wrong standard of review. Citgo Petroleum Corp.

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Bluebook (online)
38 So. 3d 498, 9 La.App. 3 Cir. 1549, 2010 La. App. LEXIS 647, 2010 WL 1779993, Counsel Stack Legal Research, https://law.counselstack.com/opinion/massingill-v-dunham-price-group-llc-lactapp-2010.