Manager's volunteering, vacationing don't wipe out benefits

In Louisiana, a worker can prove entitlement to supplemental earnings benefits by showing that her medical restrictions prevented her from earning 90 percent of her preinjury wages.

Case name: Redmann v. Bridgefield Casualty Insurance Co., No. 11-CA-651 (La. Ct. App. 02/28/12).

Ruling: The Louisiana Court of Appeal held that a manager was entitled to supplemental earnings benefits.

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What it means: In Louisiana, a worker can prove entitlement to supplemental earnings benefits by showing that her medical restrictions prevented her from earning 90 percent of her preinjury wages.

Summary: A catering and deli manager injured her back while bending over and picking up a tray of finger sandwiches. She sought treatment from a number of doctors and was unable to work for a period of time. She received workers' compensation and medical benefits. Four months after the injury, she returned to work with restrictions, including working a four-hour day, being able to alternate between sitting and standing, not carrying or lifting more than 10 pounds, and not bending or stooping. Later, the employer terminated her. A dispute arose regarding the manager's need for surgery. The employer ceased payment of benefits. The Louisiana Court of Appeal held that she was entitled to supplemental earnings benefits.

The employer argued that the manager forfeited her right to benefits because she misrepresented her physical activities in failing to disclose one instance of volunteering at her child's school and one instance of driving to another state for a vacation. The court did not find the two instances demonstrated willful misrepresentations for the purpose of obtaining benefits. The manager admitted that she volunteered in her child's school and traveled out of state after her injury. She forgot to mention her volunteer work at one event and was confused about which year she took a trip.

The court found she was entitled to supplemental earnings benefits because it was implausible that she could find a job that paid 90 percent of her preinjury wage. The court pointed out that she was restricted to working less than half of the hours she worked before she was injured.

The court also found the employer failed to reasonably controvert her claim and assessed penalties.

Read more at the WorkersComp Forum homepage.

April 16, 2012

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