Grader forfeits benefits after failing to provide complete history to doctors
Desadier v. West Frasier, Inc., No. 48,303-WCA (La. Ct. App. 08/07/13).
Ruling: The Louisiana Court of Appeal held that a grader was not entitled to benefits for his shoulder injury.
What it means: In Louisiana, a worker will forfeit benefits if he willfully makes a false statement to his doctors for the purpose of obtaining workers' compensation benefits.
Summary: A lumber grader allegedly injured his left shoulder while attempting to dislodge a piece of lumber with a pickax. He informed his supervisor on the day of the accident that he heard a loud pop in his shoulder and felt immediate pain extending from his shoulder to his elbow. The next day, he consulted a doctor and was prescribed a large quantity of hydrocodone tablets. Two weeks later, the grader consulted a different doctor and was prescribed pain medication. Nearly one year later, the grader claimed that he continued to suffer from shoulder pain. An orthopedist recommended surgery. The grader sought workers' compensation benefits. The Louisiana Court of Appeal held that he was not entitled to benefits.
The court found that the grader intentionally misled his doctors in order to obtain workers' compensation benefits. The grader had not informed any of his doctors that he had a history of injuries to his shoulder before the alleged work accident. He had injured his shoulder in a fight, a car accident, while changing a flat tire, riding an inner tube behind a boat, and falling into a boat. He had received multiple injections, pain medication, and an MRI as treatment for these injuries.
The court said it was "inconceivable" that the grader could have forgotten these injuries and treatments. The court found his omissions could only be explained as a desire to attribute his condition to the work accident. All of the grader's doctors who determined that his shoulder injury resulted from the workplace accident reversed their determination once they received a complete history of his previous shoulder injuries.
The court also pointed out that the grader's wife said that he had earned money mowing lawns for his brother's lawn care service on many occasions after the work accident. The grader explained that he did not report this to the employer because he thought his benefits would be determined at a later time. The court found that the withholding of information further strengthened a finding of fraud.
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October 28, 2013
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