Wiltz v. Luba Worker's Comp.

175 So. 3d 1046, 15 La.App. 3 Cir. 145, 2015 La. App. LEXIS 1976, 2015 WL 5833841
CourtLouisiana Court of Appeal
DecidedOctober 7, 2015
DocketNo. 15-145
StatusPublished

This text of 175 So. 3d 1046 (Wiltz v. Luba Worker's Comp.) 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
Wiltz v. Luba Worker's Comp., 175 So. 3d 1046, 15 La.App. 3 Cir. 145, 2015 La. App. LEXIS 1976, 2015 WL 5833841 (La. Ct. App. 2015).

Opinion

SAUNDERS, Judge.

|, This is a workers’ compensation case wherein the injured employee was the sole owner of a concrete finishing business. The Workers’ Compensation Judge (WCJ) found that the employee violated La. R.S. 23:1208 by fraudulently and willfully misrepresenting facts in order to obtain benefits. As such, the WCJ found that the employee forfeited his workers’ compensation benefits. Further, the WCJ ordered that the workers’ compensation insurer was entitled to restitution from the em[1048]*1048ployee in the amount of $54,570.53 under La. R.S. 23:1208(0).

The employee appealed. We find no error by the WCJ with the exception of ordering excessive restitution. We amend the WCJ’s judgment to reflect that the employee owes the workers’ compensation insurer $12,296.19 in restitution.

FACTS AND PROCEDURAL HISTORY:

Darrell Wiltz (Wiltz) is the sole owner of Wallace Wiltz Concrete, Inc., an incorporation begun by his' father that pours and finishes concrete. Wiltz worked as both the manager of the business and as one of the laborers employed by Wallace Wiltz Concrete, Inc.

On October 21, 2009, Wiltz allegedly injured his lower back while ■ lifting a tool used in the concrete finishing business. Wiltz filed a claim with LUBA workers compensation (LUBA), the workers’ compensation insurance provider for Wallace Wiltz Concrete, Inc. Between October 21, 2009, and December 3, 2009, while LUBA paid for some medical treatment requested by Wiltz, it denied authorization for requested epidural steroid injections and at no time in this interval did LUBA pay any wage benefits. Wiltz then contacted LUBA to ascertain why he was being denied these benefits.

In response, on December 3, 2009, an adjuster, on behalf of LUBA, recorded a statement .from Wiltz. In that statement, Wiltz ■ .admitted to having one previous, 12minor back injury and denied ever having been in any vehicle accidents. Thereafter, LUBA began approving medical treatment benefits and paying Wiltz Total Temporary Disability (TTD) benefit.

On April 6, 2010, LUBA performed a claim index search on Wiltz due to growing suspicion it had regarding Wiltz’s claim. The search revealed that Wiltz was involved in at least two vehicle accidents wherein he made claims and was represented by counsel.' Thereafter, LUBA obtained medical records from a host of providers that indicated Wiltz had undergone at least three MRI’s of his lower back due to complaints of pain. Further, the medical records indicated that Wiltz had various disc issues such as bulgés or hernia-tions in his lower, back and one provider diagnosed him with lumbar disc disease.

On August 17, 2011, LUBA’s adjuster called Wiltz and offered to settle the claim. When Wiltz refused, LUBA terminated Wiltz’s' benefits based on fraud under La. R.S. 23:1208.

On February 27, 2012, Wiltz filed a 1008 form for disputed compensation benefits. After discovery was conducted, a five-day trial was held. Aft,er taking the matter under advisement, the WCJ issued a judgment that Wiltz forfeited any workers’ compensation benefits due to fraud under La. R.S. 23:1208. Further, the WCJ ordered that Wiltz pay LUBA restitution of $54,570.53 under La. R.S. 23:1208(D).

Wiltz filed an appeal to this court regarding the WCJ’s judgment. In his appeal, he is alleging three assignments of error.

ASSIGNMENTS OF ERROR:

1. Was the WCJ manifestly erroneous, resulting in prejudice and legal error in awarding restitution, particularly full restitution?
[¾2. Was the WCJ manifestly erroneous, resulting in prejudice and legal error, necessitating de novo review when she incorrectly applied R.S. 23:1208 • to statements made by WILTZ in the following five (5) ways: 1) the WCJ failed to identify an actual false statement, referring only to broad categories of statements and WILTZ’ 12/3/2009 recorded statement as a whole, 2) the [1049]*1049WCJ found that WILTZ violated R.S. 23:1208 with statements made prior to his work place accident of 10/21/2009, 3) the WCJ found that WILTZ violated R.S. 23:1208 with false statements WILTZ made to his disability insurance carrier, not in furtherance of a claim for workers’ compensation benefits, 4) the WCJ penalized WILTZ under R.S. 23:1208(E) in his employee capacity for false statements made by WILTZ in his employer capacity, 5) the WCJ relied upon grossly erroneous facts, a 2005 accident resulting in a herniated lumbar disc, that are not supported by the Record in finding WILTZ was not credible' and that WILTZ made false statements in violation of R.S. 23:1208 and 6) the WCJ failed to correctly apply R.S. 23:1208(D) resulting in a wrongful award of restitution in an excessive amount.
3. That the WCJ was clearly wrong in failing to reinstate Appellee WILTZ’ indemnity and medical benefits, in failing to order payment of WILTZ out of pocket medical expenses and in failing to award penalty and attorney fees for LUBA’s arbitrary and capricious denial of this claim 8/17/2011 the same day WILTZ refused to • setting this claim for LUBA’full authority: $80,000.00.

PRELIMINARY MATTER:

Wife seeks a de novo review of the' WCJ’s finding that he willfully made false statements for the purpose of obtaining workers’ compensation -benefits in violation of La. R.S. 23:1208. Further, Wife requests a de novo review of the WCJ’s award of restitution in the amount of $54,570.83.

In support of his contentions, Wife summarizes his arguments from Assignment of Error Number Two, wherein he also asks that this court conduct a de novo review. To address this issue as both a preliminary matter and assigned error would be duplicitous. As such, we will address the issues raised by Wife in this preliminary matter when addressing Assignment of Error Number Two

1 ⅛ASSIGNMENT OF ERROR NUMBER ONE:

Wife asserts in his first assignment of error that the WCJ was manifestly erroneous in awarding restitution, or, alternatively, manifestly erroneous in awarding excessive restitution. We find no merit to the assertion that the WCJ erroneously awarded restitution, however, we do find merit .to the assertion that the WCJ erred in rewarding restitution of payments made before Wife’s alleged fraud or after LUBA became aware of Wife’s alleged fraudulent conduct!

Louisiana Revised Statutes 23:1208(D) states, in pertinent part, “[r]es-titution may only be ordered for benefits claimed or payments obtained through fraud and only up to the time the employer became aware of the fraudulent conduct.” The legislature’s use of may in La. R.S. 23:1208(D) indicates that the decision to reward restitution is discretionary'. Edwards v. Southeastern Freight Lines, Inc., 14-871 (La.App. 3 Cir. 2/4/15), 158 So.3d 227 (citing Blane Devillier Trucking, Inc. v. Authement, 03-590 (La.App. 3 Cir. 11/5/03), 858 So.2d 795; Rhone v. Boh Bros., 01-270 (La.App. 4 Cir. 12/12/01), 804 So.2d 764). As such, we will review whether the WCJ abused its discretion -in ordering Wife to pay LUBA restitution.

We find in Assignment of Error Number Two that the WCJ reasonably could have found that Wife willfully committed fraud for the purposes of obtaining workers’ compensation benefits under La. R.S. 23:1208. Thus, we also find no abuse of [1050]*1050discretion by the WCJ and affirm the decision to award restitution.

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Bluebook (online)
175 So. 3d 1046, 15 La.App. 3 Cir. 145, 2015 La. App. LEXIS 1976, 2015 WL 5833841, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wiltz-v-luba-workers-comp-lactapp-2015.