Request for half of caretaker's salary doesn't amount to fraudulent conduct
Case name: Beauregard Memorial Hospital v. Barber, No. 09-663 (La. Ct. App. 12/09/09).
The Louisiana Court of Appeal affirmed a finding that an employee with a disability did not commit fraud in her dealings with her carrier-appointed sitters.
What it means:
In Louisiana, an employer claiming that an employee has committed workers' compensation fraud must prove that: 1) there was a false statement or representation made; 2) it was willfully made; and 3) it was made for the purpose of obtaining or defeating workers' compensation benefits or payments.
Summary: A certified nursing assistant was severely injured on the job. Her doctor recommended sitter services to help her care for herself. The claimant went through a number of carrier-arranged sitters. She and the last sitter developed "hard feelings," and the claimant discharged her. The sitter called the carrier to report that the claimant required the sitters to pay her half their salaries. The carrier filed an action against the claimant claiming she violated the fraud provision of the Workers' Compensation Act by requiring the sitters to pay her money they earned from the carrier. The Court of Appeal affirmed the workers' compensation judge's finding of no fraudulent activity. The claimant did not deny that she received money from the sitters, the court noted. The court also pointed out there were no allegations that the claimant made claims for a sitter service that was not provided. The services were also recommended by the treating doctor. Therefore, the carrier failed to demonstrate the claimant made false statements for the purpose of collecting workers' compensation benefits, and its fraud claim was denied.
The court also noted that the WCJ found evidence that if the claimant received money from the sitters, it was likely that the payments were reimbursements for expenses. The WCJ found credible the claimant's explanation that she received money in one instance to cover household expenses when the sitter and her family were sharing living quarters. In other instances, the claimant explained that she requested money as reimbursement for advances on the sitter's salary or for money lent to cover expenses that the sitter could not meet at the time.
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February 4, 2010
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