Summary
The Louisiana Supreme Court held that an injured worker's willful misrepresentation of mileage reimbursement claims required forfeiture of all workers' compensation benefits under La. R.S. 23:1208. The court rejected the lower courts' limitation of forfeiture to mileage benefits and reversed their judgments. A dissent argued that the statute was ambiguous and that forfeiture should be limited to the benefits connected to the misrepresentation.
Topics
Practice areas
Questions Presented
- Whether a workers' compensation claimant who willfully makes false mileage representations to obtain mileage reimbursement must forfeit all workers' compensation benefits under LSA-R.S. 23:1208, or only the mileage reimbursement benefits directly related to the misrepresentation.
Holdings
- Under LSA-R.S. 23:1208, a claimant who willfully makes a false statement or representation for the purpose of obtaining any workers' compensation benefit or payment forfeits any right to compensation benefits under the Workers' Compensation Act. Because Duplessis willfully misrepresented mileage to obtain reimbursement, he forfeited all of his workers' compensation benefits, not merely the mileage reimbursement.
Key quotations
“After reviewing the record, statute, and relevant jurisprudence, we hold that the claimant's willful misrepresentation regarding the mileage reimbursement subjected him to the forfeiture of his workers' compensation benefits, pursuant to LSA-R.S. 23:1208.” (at 955)
“Therefore, once it is determined that a claimant has willfully made a false statement for the purposes of receiving any benefit or payment, the plain language of the statute mandates that the "right to compensation benefits" under the Workers' Compensation Act are forfeited.” (at 960)
Factual background
Jack Duplessis, a former truck driver for the St. Bernard Parish Police Jury, received workers' compensation disability and medical benefits after injuring his knee at work. He submitted mileage reimbursement forms claiming 4,354 miles for travel to medical providers, although the evidence showed that he was entitled to reimbursement for only 1,114.2 miles. The OWC found that he willfully submitted false mileage reports to obtain additional reimbursement, but limited the forfeiture to the mileage benefits rather than all workers' compensation benefits.
Procedural history
The Office of Workers' Compensation found that Duplessis willfully submitted false mileage reports but limited the forfeiture to the claimed mileage benefits and referred the matter to the OWC Fraud Section. The court of appeal affirmed, holding that the misrepresentation did not require forfeiture of disability benefits. The Louisiana Supreme Court reversed both judgments.