Worker entitled to TTD benefits despite nonwork-related Huntington's

In Louisiana, a worker is not entitled to benefits if he willfully makes a false statement or representation for the purpose of obtaining or defeating a benefit or payment.

Case name: Keys v. Republic Services, Inc., No. 12-252 (La. Ct. App. 10/03/12).

Ruling: The Louisiana Court of Appeal held that a worker was entitled to temporary total disability benefits even though his memory loss unrelated to the work accident prevented him from providing a complete medical history to doctors.

Lack of fixed work site makes car crash compensable (02/25/13)
Failure to tell doctor pain was work-related doesn't curb benefits (02/25/13)
Employer liable for medical care related to latent, progressive injury (02/25/13)
Claim timely filed within 2 years of fatal heart attack (11/01/12)
Late payments, denial of treatment entitle worker to attorney's fees (09/30/11)

What it means: In Louisiana, a worker is not entitled to benefits if he willfully makes a false statement or representation for the purpose of obtaining or defeating a benefit or payment.

Summary: A worker claimed that he was injured in the course and scope of his employment while lifting a hot water tank into the back of a truck. The employer paid benefits for one year. When the employer ceased paying benefits, the worker filed a disputed claim for benefits. The worker also had Huntington's disease that caused dementia and memory loss. The employer claimed that he was not entitled to benefits because he willfully made false statements regarding his prior medical history. The Louisiana Court of Appeal held that the worker was entitled to TTD benefits and ordered the employer to pay penalties and attorney's fees.

The court agreed with the workers' compensation judge's finding that the worker did not willfully misrepresent his medical history for the purpose of obtaining benefits. His Huntington's disease affected his ability to remember previous events.

The employer asserted that the worker was not entitled to TTD benefits because his treating physician confirmed that his current condition was caused by Huntington's disease, which was not related to his work injury. Also, the worker would be back to work but for the Huntington's disease. The court found that the worker met his burden of proving that he was temporarily totally disabled, regardless of the effects of his Huntington's disease. The court pointed out that the worker's physician never released him to any employment.

The court ordered the employer to pay penalties and attorney's fees. The WCJ stated that the employer "ignored" the worker's condition due to the work-related accident and focused on his inability to work because of his Huntington's disease. The employer's termination of benefits was arbitrary and capricious.

A dissenting judge disagreed with the order of penalties and attorney's fees, pointing out that the worker "repeatedly misrepresented" his medical history to doctors and the WCJ.

Read more at the WorkersComp Forum homepage.

January 3, 2013

Newsletter Sign-up