State v. Douglas

842 N.E.2d 1073, 164 Ohio App. 3d 467, 2005 Ohio 6144
CourtOhio Court of Appeals
DecidedNovember 18, 2005
DocketNo. L-04-1055.
StatusPublished
Cited by4 cases

This text of 842 N.E.2d 1073 (State v. Douglas) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State v. Douglas, 842 N.E.2d 1073, 164 Ohio App. 3d 467, 2005 Ohio 6144 (Ohio Ct. App. 2005).

Opinion

Skow, Judge.

{¶ 1} Appellant, William Douglas, appeals his conviction in the Lucas County Court of Common Pleas for workers’ compensation fraud. For the reasons that follow, the conviction is affirmed.

*469 {¶ 2} Appellant was indicted for workers’ compensation fraud, a violation of R.C. 2913.48, as a felony of the fourth degree. Specifically, the indictment charged that “from on or about March 23, 2001 to on or about July 24, 2001,” appellant, “with purpose to defraud, or knowing that he was facilitating a fraud, did receive workers’ compensation benefits to which he was not entitled, and/or did make or present, or cause to be made or presented a false or misleading statement with the purpose to secure payment for goods or services rendered under Chapter 4121., 4123., 4127., or 4131 of the Revised Code or to secure workers’ compensation benefits, and the value of the goods, services, property, or money stolen is five thousand dollars ($5,000.00) or more, and less than one hundred thousand dollars ($100,000.00), in violation of Ohio Revised Code § 2913.48, Workers’ Compensation Fraud, a Felony of the Fourth Degree.”

{¶ 3} R.C. 2913.48 provides:

{¶ 4} “(A) No person, with purpose to defraud or knowing that the person is facilitating a fraud shall do any of the following:

{¶ 5} “(1) Receive workers’ compensation benefits to which the person is not entitled;

{¶ 6} “(2) Make or present or cause to be made or presented a false or misleading statement with the purpose to secure payment for goods or services rendered under Chapter 4121., 4123., 4127., or 4131. of the Revised Code or to secure workers’ compensation benefits[.]”

{¶ 7} Reading the statute in conjunction with the indictment makes clear that appellant was indicted in the alternative under R.C. 2913.48(A)(1) and (A)(2).

{¶ 8} The following facts were adduced at trial. On June 8, 2000, appellant suffered a back and leg injury while working as an asphalt laborer. He subsequently applied for and received temporary total disability (“TTD”) benefits from the Ohio Bureau of Workers’ Compensation (“BWC”).

{¶ 9} The BWC awards TTD benefits to injured workers who are temporarily unable to work in any capacity as a result of a work-related injury. Claimants are not entitled to TTD benefits over any period in which they work. A claimant who does work, in any capacity, during his or her disability period is required to report this activity to the BWC. In addition, because the amount of TTD benefits to which a claimant is entitled is reduced by the amount of any unemployment benefits received, claimants are also required to report any unemployment income they may have received over the disability period.

{¶ 10} In order to receive TTD benefits, injured workers must have their disability certified to the BWC by a physician. The physician, after speaking to and examining the claimant, determines whether to certify the disability on a C- *470 84 application for TTD benefits. The C-84 is then submitted to the BWC for consideration in determining benefits.

{¶ 11} The C-84 is a two-page document. The first page contains information about the claimant’s injury, work activity, and other benefits received or applied for. The claimant verifies the information by signing the first page, just beneath an acknowledgement that he or she is not permitted to work while receiving TTD benefits. The acknowledgment further provides that the claimant has answered the application questions truthfully and that the claimant could be subject to criminal prosecution for making false statements or for knowingly receiving compensation to which he or she is not entitled.

{¶ 12} The second page of the C-84 is completed by the claimant’s treating physician or physician of record. The physician of record supplies information such as the nature and extent of the claimant’s injury, the claimant’s job at the time of the injury, whether the claimant is capable of returning to work, the time period over which the claimant will be unable to return to work, and the return-to-work date.

{¶ 13} When the initial paperwork for a new TTD benefits claim is submitted to the BWC, the claim is assigned to a claims service specialist. The claims service specialist reviews the information contained within the C-84 form to determine whether the claimant is eligible for TTD benefits.

{¶ 14} The TTD benefits period is based on the disability dates that the physician of record notes on the C-84. When the claimant’s disability continues beyond the initial benefits period, a new C-84 may be filed on the claimant’s behalf in order to extend the benefits for an additional period.

{¶ 15} In the instant case, appellant received TTD benefits over broken periods from August 15, 2000, to April 10, 2002. As indicated above, appellant’s indictment targeted a time period from on or about March 23, 2001, to on or about July 24, 2001.

{¶ 16} During the period set forth in the indictment, appellant signed two C-84 forms: one on May 12, 2001, and another on June 25, 2001. Each form warned that he was not entitled to TTD benefits if he worked. Further, throughout appellant’s TTD claim period, appellant was paid by BWC warrants, each of which warned that he was not entitled to the money if he worked.

{¶ 17} Despite these rules for entitlement, and the related warnings to appellant, appellant worked for three different employers over the period that he claimed he was disabled. From March 23, 2001, to March 25, 2001, he worked as a security guard for Raceway Park, where he worked approximately 15.5 hours and earned $108. From April 21, 2001, to June 30, 2001, he worked as an asphalt laborer for Cappelletty Brothers, where he worked approximately 231 hours and *471 earned $2,422.88. And, finally, from June 21, 2001, to July 24, 2001, he worked as an asphalt laborer for Atlas Paving, where he worked 179 hours and earned $4,010.59.

{¶ 18} In addition to misrepresenting his work history to both the BWC and his physicians in connection with the C-84 pages that he signed on May 12, 2001, and June 25, 2001, appellant failed to otherwise notify the BWC of any of these work activities. On the two relevant C-84s, appellant reported that he last worked on June 8, 2000.

{¶ 19} Appellant also indicated on those forms that he had not received any employment benefits during his disability period. In fact, appellant did receive unemployment benefits over the period covered by the indictment.

{¶ 20} The BWC relied on the C-84s when determining whether TTD benefits should be awarded to appellant. According to testimony by BWC claims specialist Cowenda Wood, had appellant indicated on one of those forms that he had worked during his disability period, the BWC would not have awarded him TTD benefits.

{¶ 21} Similar testimony was given by Fred Ho-A-Lim, M.D., who was appellant’s physician from March 2001, to September 2001. According to Dr. Ho-A-Lim, he certified appellant’s disability and completed C-84 forms — including several signed during the indictment period — based on information that appellant provided to him during his office visits.

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Cite This Page — Counsel Stack

Bluebook (online)
842 N.E.2d 1073, 164 Ohio App. 3d 467, 2005 Ohio 6144, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-v-douglas-ohioctapp-2005.