Williams v. Holly Hill Nursing Home

640 So. 2d 383, 93 La.App. 3 Cir. 557, 1994 La. App. LEXIS 874, 1994 WL 102429
CourtLouisiana Court of Appeal
DecidedMarch 30, 1994
Docket93-557
StatusPublished
Cited by13 cases

This text of 640 So. 2d 383 (Williams v. Holly Hill Nursing Home) 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
Williams v. Holly Hill Nursing Home, 640 So. 2d 383, 93 La.App. 3 Cir. 557, 1994 La. App. LEXIS 874, 1994 WL 102429 (La. Ct. App. 1994).

Opinion

640 So.2d 383 (1994)

Emma WILLIAMS, Plaintiff-Appellant,
v.
HOLLY HILL NURSING HOME, Defendant-Appellee.

No. 93-557.

Court of Appeal of Louisiana, Third Circuit.

March 30, 1994.

*384 Louis D. Bufkin, Lake Charles, for Emma Williams.

John E. Bergstedt, Lake Charles, for Holly Hill Nursing Home.

Before LABORDE, THIBODEAUX, DeCUIR, KNOLL and COOKS, JJ.

LABORDE, Judge.

This appeal arises from a workers compensation proceeding instituted by Emma Williams against her employer, Holly Hill Nursing Home, Inc. The sole issue on appeal is whether the hearing officer properly applied LSA-R.S. 23:1208.1 to bar Williams' benefits.

Being of the view that the provision precludes recovery of benefits to those failing to answer truthfully employer's questions directly related to a medical condition, not a body region, for which workers compensation benefits is sought, we reverse.

FACTS

On July 22, 1991, Emma Williams applied for employment with Holly Hill. As part of this application, Ms. Williams completed a standard pre-employment questionnaire concerning her physical condition and medical history. Among the questions on the questionnaire were the following:

A. Have you ever had problems with your back, neck, etc.?
B. Has a doctor ever restricted your activities?
C. Have you ever received treatment for your back, neck or knee from a doctor, chiropractor or therapist? and
D. Have you ever had an injury which required you to miss time from work?

The questionnaire explained that if the applicant answered yes to any of these questions, the applicant was to provide detailed information concerning her medical history. Additionally, pursuant to statute, the questionnaire contained a statement prominently displayed in bold faced block lettering, warning the applicant that a failure to answer truthfully could result in the denial of workers compensation benefits.

Ms. Williams answered "no" to these questions and was hired by Holly Hill as a nurse's assistant. She began work July 24, 1991. On that very same day, Ms. Williams injured her back while lifting a patient. From the date of her accident, Ms. Williams was treated conservatively by Dr. Charles Fellows, a family practitioner. Nonetheless, Ms. Williams worked steadily until August 21, 1991, before missing work between August 21 and 26, 1991, and again on September 2 and 3. With no recovery in sight, Dr. Fellows eventually took her off work indefinitely. Her compensation benefits began on September 4, 1991.

Additionally, Ms. Williams was seen by Dr. Bill Foster, a neurologist, on November 19, *385 1991. According to Dr. Foster's report, he had treated Ms. Williams previously for a back injury relating to a 1987 automobile accident, but that she had fully recovered and remained asymptomatic until her 1991 work-related injury. Dr. Foster diagnosed a severe lumbar strain and probable herniated disc, and related both to her 1991 work injury. He recommended further examinations to rule in or rule out his initial diagnosis.

Holly Hill terminated Ms. Williams' benefits on December 3, 1991, relying on the provisions of LSA-R.S. 23:1208.1. The reason for the termination was explained to Ms. Williams in a letter dated December 6, 1991, wherein it was explained to her that her benefits were being terminated for her failure to truthfully answer the pre-employment questionnaire.

After her benefits were terminated, Ms. Williams filed a claim form 1008 seeking reinstatement of benefits. Holly Hill denied Williams' petition based on her pre-employment application responses and LSA-R.S. 23:1208.1. Following argument and briefing by the parties, the hearing officer denied Ms. Williams' claims. This appeal followed.

LAW AND DISCUSSION

The governing statute reads as follows:

§ 1208.1. Employer's inquiry into employee's previous injury claims; forfeiture of benefits
Nothing in this Title shall prohibit an employer from inquiring about previous injuries, disabilities, or other medical conditions and the employee shall answer truthfully; failure to answer truthfully shall result in the employee's forfeiture of benefits under this Chapter, provided said failure to answer directly relates to the medical condition for which a claim for benefits is made or affects the employer's ability to receive reimbursement from the second injury fund. This Section shall not be enforceable unless the written form on which the inquiries about previous medical conditions are made contains a notice advising the employee that his failure to answer truthfully may result in his forfeiture of worker's compensation benefits under R.S. 23:1208.1. Such notice shall be prominently displayed in bold faced block lettering of no less than ten point type.
Added by Acts 1988, No. 938, § 2, eff. Jan. 1, 1989. Amended by Acts 1989, No. 454, § 5, eff. Jan. 1, 1990.

(Emphasis added).

The forfeiture of workers compensation benefits contemplated by LSA-R.S. 23:1208.1 is expressly conditioned upon the presence of three factors: an untruthful statement; a direct relationship between the answer elicited and the claim for benefits or ability to receive reimbursement from the second injury form; and compliance with the notice requirements of the statute. Want of any of the three factors is fatal to the employer's successful avoidance of workers compensation liability on grounds of past[1] artifice.

As might be surmised by the underscored language in LSA-R.S. 23:1208.1, the question we address is whether her "failure to [truthfully] answer directly relates to the medical condition for which a claim for benefits is made." It is undisputed that Williams failed to answer truthfully on her pre-employment questionnaire regarding her previous lumbar injury, missed work, and prior medical treatments. Additionally, plaintiff concedes that the employer complied with the notice requirements set forth above. Consequently, the question is whether plaintiff's failure to answer relates directly to the medical condition for which the present claim for benefits is made.

Answering affirmatively, the hearing officer (who admitted to never having read the reports of plaintiff's treating physician) concluded that plaintiff's failure to answer truthfully directly concerned her previous injury because both the earlier and later injuries relate to the same geographical region of her body. Concededly, this conclusion is consistent with what appears to be the only reported decision to date concerned with articulating what is meant by the operative language "directly related to" found in the statute, that of the First Circuit in Carter v. *386 Our Lady Regional Med. Center, 612 So.2d 805, 807 (La.App. 1st Cir.1992) ("The injuries in the 1989 and 1990 accidents were to the exact same areas.").

We differ with the legal interpretations of the hearing officer and the First Circuit, and reverse on that basis. In our opinion the express conditional language contained in LSA-R.S. 23:1208.1 serves to narrow the sweep of the forfeiture provision to require more than geographical identity. Had the law intended to bar relief for any misleading statements or based solely on the anatomical region affected, it could have done so.

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640 So. 2d 383, 93 La.App. 3 Cir. 557, 1994 La. App. LEXIS 874, 1994 WL 102429, Counsel Stack Legal Research, https://law.counselstack.com/opinion/williams-v-holly-hill-nursing-home-lactapp-1994.