St. Bernard Parish Police Jury v. Duplessis

831 So. 2d 955, 2002 WL 31716171
Supreme Court of Louisiana·Decided December 4, 2002·No. 2002-C-0632·Published·Cited by 18 cases

Opinion

831 So.2d 955 (2002)

ST. BERNARD PARISH POLICE JURY and Travelers Property Casualty Corporation
v.
Jack DUPLESSIS.

No. 2002-C-0632.

Supreme Court of Louisiana.

December 4, 2002.

Christopher M. Landry, Metairie, Christopher K. LeMieux, BLUE WILLIAMS, Counsel for Applicant.

Robert A. Caplan, New Orleans, Diane R. Lundeen, LEWIS & CAPLAN, Counsel for Respondent.

JOHNSON, Justice.

We granted this writ of certiorari to determine whether an injured worker, who has made willful misrepresentations regarding mileage reimbursement, has forfeited his right to all workers' compensation benefits. After reviewing the record, statute, and relevant jurisprudence, we hold that the claimant's willful misrepresentation regarding the mileage reimbursement subjected him to the forfeiture of his workers' compensation benefits, pursuant to LSA-R.S. 23:1208. Accordingly, the judgments of the OWC and court of appeal are hereby reversed.

FACTS AND PROCEDURAL HISTORY

Claimant, Jack Duplessis, was formerly employed by the St. Bernard Parish Police Jury as a truck driver in the Sanitation Department. Mr. Duplessis injured his *956 knee during the course and scope of his employment and began receiving workers' compensation disability and medical benefits in 1991.

In 1999, the employer's insurer, Travelers Casualty and Surety Company ("Travelers") became suspicious that Mr. Duplessis was submitting falsified mileage reports. In connection with his claim, Mr. Duplessis had submitted mileage reimbursement forms, requesting reimbursement for 4,354 miles that he claimed to have traveled to receive medical services. Specifically, Mr. Duplessis alleged that he traveled 48 miles, round trip, to his physician's office; 44 miles, round trip, to St. Bernard Drugs; and 22 miles, round trip, to Wendling's Pharmacy. Travelers engaged the services of an investigator to verify the accuracy of the mileage submitted. The investigation revealed that the round-trip mileage from Mr. Duplessis's home to his physician's office was 15.8 miles. The mileage from Mr. Duplessis's home to St. Bernard Drugs was 8.2 miles, round trip. The round trip mileage from Mr. Duplessis's home to Wendling's Pharmacy was one (1) mile. The evidence showed that Mr. Duplessis was only entitled to reimbursement for 1,114.2 miles, rather than for the 4,354 miles he claimed.

The employer and Travelers filed a petition, alleging that Mr. Duplessis violated Section 1208 of the Louisiana Workers' Compensation Act[1] by willfully submitting the false mileage reports. Petitioners requested that Mr. Duplessis's workers' compensation benefits be forfeited based upon the misrepresentation of the mileage. Mr. Duplessis opposed the petition, contending that he did not intentionally or willfully misrepresent the mileage. Although the record reveals that Mr. Duplessis has a high school education, he argued that he has a limited education, and he simply made a mistake. Despite being a truck driver, Mr. Duplessis testified at trial that he was confused about what constitutes a "round trip." That testimony directly contradicted his deposition testimony in which he stated that he knew a round trip to be a trip to a specific destination and back. According to Mr. Duplessis's trial testimony, he and a friend drove back and forth several times from his home to the location of each medical provider to determine the mileage for a round trip. For example, he testified that he drove back and forth from his home to Dr. Diaz's office four times to come up with the 48 miles that he listed as a round trip on the reimbursement form.

After a trial on the issue, the Office of Workers' Compensation ("OWC") hearing officer stated:

The Court found Claimant to be an incredible witness. This man had been a truck driver for the parish. This Court does not believe that Claimant could not read an odometer. He has submitted mileage reports before. There was no indication that Claimant had recently moved. The Court believes that Claimant knew the mileage to the doctor's *957 office and the two pharmacies. Regardless of Claimant's contentions to the contrary, the Court does not believe that all of the fault here lay with Claimant's now deceased friend.[2] Claimant signed the certification. This Claimant is not a workers' compensation neophyte.

The hearing officer found that Mr. Duplessis "violated Section 1208 of the Louisiana Workers' Compensation Act by willfully submitting false mileage reports in the expectation of being paid for same." Nevertheless, the hearing officer concluded that the forfeiture of all workers' compensation benefits was "too harsh under the circumstances." Instead, the hearing officer found "the forfeiture of the requested mileage and referral to the Fraud Section to be sufficient." Accordingly, the hearing officer ordered Mr. Duplessis to forfeit all payment for the mileage benefits he claimed and referred the matter to the OWC Fraud Section.

The employer and Travelers appealed the hearing officer's ruling, arguing that the hearing officer erred in failing to order the forfeiture of all of Mr. Duplessis's workers' compensation benefits.[3] The court of appeal affirmed the ruling, finding that a claimant who has misrepresented his mileage expenses should not be disqualified from receiving disability benefits. St. Bernard Parish Police Jury v. Duplessis, 00-2667 (La.App. 4 Cir. 1/30/02), 809 So.2d 479. By order dated May 24, 2002, this court granted the employer's and Travelers' writ application. 02-0632 (La.5/24/02), 816 So.2d 293.

DISCUSSION

The employer and Travelers argue that because Mr. Duplessis willfully submitted false mileage reports, he has forfeited his right to any workers' compensation benefits, pursuant to LSA-R.S. 23:1208. Conversely, Mr. Duplessis contends that the OWC's finding that he forfeited only his rights to mileage reimbursement is a sufficient remedy because it sufficiently penalizes him "by losing the right to a particular benefit to which he would have otherwise been entitled, without losing benefits beyond those related to the false statement."

While this court has never visited the issue of whether a claimant, who fraudulently claims reimbursement for mileage, forfeits his right to compensation benefits, several courts of appeal of this state have. In Chenault v. Storehouse Furniture, 97-1242 (La.App. 4 Cir. 1/28/98), 706 So.2d 1060; writ denied, 98-0364 (La.3/27/98), 716 So.2d 889, the claimant filed a request for his travel expenses between his residence in Fort Worth, Texas to the New Orleans area. His employer filed a motion to dismiss the claimant's workers' compensation claim, alleging that he had requested mileage reimbursement for travel which had not taken place and that the actual distance between Fort Worth and New Orleans was "substantially less" than claimed. The OWC dismissed the claimant's workers' compensation claim, finding that he had forfeited benefits due to the misrepresentation of the mileage. The Fourth Circuit Court of Appeal reversed *958 the OWC's ruling, finding that the employer failed to prove that the claimant willfully misrepresented the number of miles he traveled to obtain medical treatment.[4] However, the court indicated that misrepresentations about mileage expenses should not disqualify a claimant from receiving disability benefits, stating:

We further question whether the alleged misrepresentation in this case justifies forfeiture of workers' compensation benefits under Section 1208.
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St. Bernard Parish Police Jury v. Duplessis, 831 So. 2d 955, 2002 WL 31716171 (La. 2002).

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