Moss v. Winward Hosp.

720 So. 2d 107, 1998 WL 690719
CourtLouisiana Court of Appeal
DecidedOctober 7, 1998
Docket98-401
StatusPublished
Cited by3 cases

This text of 720 So. 2d 107 (Moss v. Winward Hosp.) 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
Moss v. Winward Hosp., 720 So. 2d 107, 1998 WL 690719 (La. Ct. App. 1998).

Opinion

720 So.2d 107 (1998)

David MOSS, Plaintiff-Appellee,
v.
WINWARD HOSPITAL, Defendant-Appellant.

No. 98-401.

Court of Appeal of Louisiana, Third Circuit.

October 7, 1998.

*108 Susan Ford Fiser, Alexandria, for David Moss.

Charles J. Foret, Lafayette, for Winward Hosp.

Before YELVERTON, PETERS and AMY, JJ.

AMY, Judge.

In this workers' compensation matter, the lower court concluded that the claimant's Charcot foot condition was a work-related accident which aggravated a pre-existing diabetic condition. As a result, the claimant was awarded temporary total disability and medical benefits. The defendant appeals. For the reasons which follow, we affirm in part and reverse in part.

Factual and Procedural History

The claimant in this matter, David Moss, alleges that while in the course and scope of his employment as a maintenance worker with the defendant, Winward Hospital, he sustained a condition known as Charcot foot. He maintains that this condition arose in July 1996 when he and his supervisor, *109 Charles Humphries, were moving hospital beds. He asserts that his foot began to immediately swell, that he told Humphries of the injury and that, at the time, he felt that he had only sustained a sprain. On the day following the alleged accident, the claimant stayed at home because of the swollen foot but returned to work later in the week. Following a few additional days of working, the claimant reported to the Veterans Administration Hospital in Pineville, Louisiana.

Moss testified that, after the August 2, 1996 visit to the VA hospital, he was given medication and released. He then returned to work. However, a blister developed on his foot and prompted the claimant's return to the hospital. He was admitted on this visit and was diagnosed as having a condition known as Charcot foot. The claimant's treating podiatrist, Dr. Robert Butler, explained that this condition occurs in people who have lost sensation in their feet, in particular, those who have lost sensation due to diabetes. He testified in deposition that after sensation is lost, the patient can overuse the foot to a point where the physiology changes and the bones break. Dr. Butler stated that, in the claimant's case, the bones in his foot broke at the Lisfranc's Joint. Dr. Butler further opined that the claimant's condition is permanent and will prevent a return to work.

After both disability and medical benefits were refused by the defendant, the claimant filed a Disputed Claim for Compensation on February 7, 1997. He asserted that he was entitled not only to benefits, but to attorney's fees and penalties as well. Winward answered the claim and asserted that Moss is precluded from benefits due to violation of La.R.S. 23:1208 and La.R.S. 23:1208.1. The defendant argued that the claimant knew that he was diabetic at the time he was hired, that he withheld this information, and that, further, he made false statements regarding his injury in order to receive workers' compensation benefits. Following a hearing on the matter, the workers' compensation judge found in Moss' favor awarding temporary total disability benefits and medical benefits "including but not limited to treatment for Charcot foot and diabetes." However, the judge found that imposition of attorney's fees and penalties was not warranted. Furthermore, the workers' compensation judge found that the employee did not violate La.R.S. 23:1208 nor La.R.S. 23:1208.1.

Winward appeals and assigns the following as error:

1. The Workers' Compensation Judge erred when she did not disqualify David Moss from receipt of workers' compensation benefits due to his violation of LSA— R.S. 23:1208, the Workers' Compensation Act's fraud statute.
2. The Workers' Compensation Judge erred when she did not disqualify David Moss from receipt of workers' compensation benefits due to his violation of LSA-R.S. 23:1208.1, the Workers' Compensation Act's pre-existing disclosure provision.
3. The Workers' Compensation Judge erred in finding David Moss had proven he had sustained an accident within the course and scope and arising out of his employment with Winward Hospital.
4. The Workers' Compensation Judge erred when she held Winward Hospital was responsible for treatment of David Moss' pre-existing diabetic condition.

Discussion

La.R.S. 23:1208

In the first assignment of error, Winward argues that Moss made fraudulent statements regarding the alleged accident in order to receive workers' compensation benefits. Therefore, according to the defendant, La.R.S. 23:1208 precludes recovery of such benefits. Specifically, the defendant asserts that, contrary to the claimant's testimony, Charles Humphries stated that the claimant did not report to him that he injured his foot while moving the hospital beds. Furthermore, the defendant claims that the claimant never told hospital personnel that his injury was work-related until after learning that he had broken bones in his foot.

La.R.S. 23:1208 provides 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 *110 for any other person, to willfully make a false statement or representation.
E. Any employee violating this Section shall, upon determination by workers' compensation judge, forfeit any right to compensation under this Chapter.

In interpreting this provision, the Louisiana Supreme Court has stated that:

The only requirements for disqualification under Section 1208 are: 1) a false statement or representation, 2) which is willfully made, and 3) which is made for the purpose of obtaining workers' compensation benefits. If these requirements are met, Section 1208 applies and its forfeiture provisions must be enforced.

Resweber v. Haroil Const. Co., 94-2708, p. 11 (La.9/5/95); 660 So.2d 7, 14. In application of La.R.S. 23:1208 and Resweber, a panel of this court stated that "[t]he statute and Resweber are intended to weed out those who prey on the compensation system through the use of lies and deceit." Sumner v. Lake Charles Marine, 96-280, p. 5 (La.App. 3 Cir. 6/5/96); 676 So.2d 653, 656, writ denied, 96-1772 (La.10/11/96); 680 So.2d 645.

In oral reasons for ruling in the present matter, the workers' compensation judge stated that the claimant was credible in his version of events and, furthermore, that "there was no intent to deceive either the employer or this Court in order to obtain workers' compensation benefits." When considering such factual determinations, the appellate court must review the matter under the manifest error or clearly wrong standard of review. Alexander v. Pellerin Marble & Granite, 93-1698 (La.1/14/94); 630 So.2d 706.

Our review of the record reveals no manifest error in the lower court's determination that recovery is not precluded by La. R.S. 23:1208. We find no evidence which would compel a finding that the claimant made false statements in order to procure workers' compensation benefits. Instead, the claimant testified that, at the time of the alleged accident, he informed Charles Humphries that he thought that he had hurt his foot while moving the bed. While this statement conflicts with Humphries' denial of such a report, the workers' compensation judge found the claimant's testimony to be credible.

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Bluebook (online)
720 So. 2d 107, 1998 WL 690719, Counsel Stack Legal Research, https://law.counselstack.com/opinion/moss-v-winward-hosp-lactapp-1998.