Case name: Stonetrust Commercial Insurance Co. v. George, No. 46,560-WCA (La. Ct. App. 09/28/11).
The Louisiana Court of Appeal held that an insurer improperly terminated a driver's benefits, entitling him to penalties and attorney's fees.
means: In Louisiana, an employer has a duty to fully investigate a worker's medical status before terminating benefits.
A log truck driver suffered neck pain and post-traumatic stress disorder after being involved in a motor vehicle accident in which two women in the other vehicle were killed. He was unable to work. His employer's insurer began paying temporary total disability benefits. Later, he was arrested and charged with possession of marijuana with intent to distribute, resisting arrest, and battery of a police officer. A newspaper ran a story on the arrest, stating that he hit a police officer. The insurer terminated the driver's benefits, reasoning that he was capable of driving a truck if he could assault a police officer and deal drugs. The driver sought to have his benefits resumed. The Louisiana Court of Appeal held that the insurer improperly terminated the driver's benefits, entitling him to penalties and attorney's fees.
The court explained that a "reasonably reliable determination" that the driver was not entitled to benefits could not be made from the newspaper article. Additionally, the article reported facts contrary to the arresting officer's testimony. The officer said he locked the driver's arms down so he could not strike him. The court explained that there was no medical basis for terminating benefits. At the time the insurer terminated benefits, the driver was being treated regularly and his doctor had not released him to return to work.
The court also noted that the driver did not forfeit his right to benefits due to his arrest.
The court said the driver's statements regarding his illegal drug use, the reason he stopped working, and the details of his arrest would not have precluded him from receiving benefits, so they did not constitute fraud justifying a forfeiture of benefits. The statements did not directly relate to his work-related injury or treatment and were not made with the intent to obtain benefits.
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November 7, 2011
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