Thibodeaux v. Mechanical Construction Co.

52 So. 3d 1084, 10 La.App. 3 Cir. 739, 2010 La. App. LEXIS 1688, 2010 WL 4967823
CourtLouisiana Court of Appeal
DecidedDecember 8, 2010
Docket10-739
StatusPublished
Cited by2 cases

This text of 52 So. 3d 1084 (Thibodeaux v. Mechanical Construction Co.) 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
Thibodeaux v. Mechanical Construction Co., 52 So. 3d 1084, 10 La.App. 3 Cir. 739, 2010 La. App. LEXIS 1688, 2010 WL 4967823 (La. Ct. App. 2010).

Opinion

AMY, Judge.

hThe employer appeals a judgment in favor of the claimant finding that the claimant sustained a compensable work-related accident and was entitled to reasonable and necessary medical treatment related to certain cervical complaints. For the following reasons, we affirm.

Factual and Procedural Background

The claimant, John Thibodeaux, alleges he was involved in a work-related accident on August 20, 2007, while working as a plumber for the defendant employer, Mechanical Construction Company, L.L.C. (MCC). At trial, the claimant testified that he was on a ladder pulling pipe through metal hangars when he started experiencing severe pain in his left shoulder. Because of the shoulder pain, the claimant believed he was having a heart attack and he alerted his supervisor, Willis Anderson. Mark Joffrion, an assistant *1087 project manager with the defendant employer, drove the claimant to St. Patrick’s Hospital in Lake Charles, where it was determined the claimant was not having a heart attack and he was subsequently discharged.

Two days after his alleged accident, the claimant visited his primary care physician, Dr. Michael Felton, and complained of pain in his left shoulder and neck. 1 Dr. Felton ordered an MRI of the claimant’s left shoulder and referred him to Dr. Frederick Mayer, an orthopaedic surgeon, and Dr. Vikram Parmar, an orthopaedic surgeon specializing in spinal disorders and orthopaedic trauma.

Dr. Parmar’s report, dated August 29, 2007, diagnosed the claimant with a complete traumatic rotator cuff tear, a degenerative rotator cuff tear, and “multilevel spinal stenosis from C3 to C7.” In that report, Dr. Parmar opined, “I think the |2majority of the symptoms are coming from this acute rotator cuff tear. I will address the spine pathology after the shoulder is fixed.” In a report dated September 6, 2007, Dr. Mayer stated that the claimant “presents with degenerative arthritis in the right and left AC joints with complete tears of the supraspinatus tendons on the left and right shoulders with restriction of active abduction in the left shoulder only.” He recommended surgery on the claimant’s left shoulder to repair his torn rotator cuff, which was subsequently performed on January 4, 2008.

On June 11, 2008, the claimant filed a Disputed Claim for Compensation against MCC and its workers’ compensation insurer, The Gray Insurance Company, seeking the authorization of medical treatment by Dr. Parmar and attorney fees and penalties for the untimely payment of indemnity benefits. The employer and insurer answered, generally denying the claimant’s allegations. After being granted leave of court, the employer and insurer filed an amended answer asserting that the claimant forfeited entitlement to benefits in that he “denied pre-alleged accident complaints, injury or problems to other medical providers, including but not limited to Dr. Parmar” in contravention of La.R.S. 23:1208 and denied prior injuries and complaints in a MCC post-hire medical questionnaire in contravention of La.R.S. 23:1208.1.

Following trial, the workers’ compensation judge issued judgment: finding the claimant proved that he sustained a com-pensable accident in the course and scope of employment; finding the claimant proved that his neck and cervical spine were injured in the work-related accident and that he was entitled to treatment for his neck and cervical spine; finding that the claimant’s lower back was not injured in the subject accident; and that the claimant was not entitled to penalties and attorney fees. In its oral reasons for judgment, the workers’ compensation judge found that the claimant did not forfeit benefits for violating La.R.S. 23:1208 or La.R.S. 23:1208.1.

1 sThe employer and insurer appeal, asserting that the workers’ compensation judge erred in: (1) denying its defense under La.R.S. 23:1208; (2) finding that the claimant met his burden of proving he was involved in a compensable accident; (3) finding that the claimant met his burden of proving a causal relationship between his cervical complaints and the alleged acci *1088 dent; and (4) denying its defense under La.R.S. 23:1208.1.

Discussion

Louisiana Revised Statutes 23:1201

The employer first argues that the trial court erred in denying its defense under La.R.S. 23:1208 in light of the claimant’s alleged misrepresentations of his prior conditions in his deposition, a recorded interview, and to his treating physicians.

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

An employer claiming that 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 14benefit or payment.” Resweber v. Haroil Constr. Co., 94-2708, p. 7 (La.9/5/95), 660 So.2d 7, 12. The supreme court further explained:

[T]he 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 of obtaining benefits. Clearly, an inadvertent and inconsequential false statement would not result in forfeiture of benefits.

Id. at 16.

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

With respect to a claim for 1208:
Mr. Thibodeaux did deny prior neck problems. The records do show prior complaints of neck problems. I don’t feel that Mr. Thibodeaux was intentionally misrepresenting it. He seemed very surprised at the prior neck complaint found in the records. And I accept that as genuine. You know, I can say it’s a coin toss. I don’t know. But the burden of proving fraud is on the employer/insurer, on the defendant; and each element has to be proven. I cannot say that the burden has been meant [sic] proving willfulness of the misrepresentations. There were misrepresentations. I cannot say they were willful.
I did find Mr. Thibodeaux to be a credible witness.

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Cite This Page — Counsel Stack

Bluebook (online)
52 So. 3d 1084, 10 La.App. 3 Cir. 739, 2010 La. App. LEXIS 1688, 2010 WL 4967823, Counsel Stack Legal Research, https://law.counselstack.com/opinion/thibodeaux-v-mechanical-construction-co-lactapp-2010.