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Appeals court confirms falsifying medical history negates workers' compensation claim

Lawsuits

By Scott Holland | Apr 4, 2019


NEW ORLEANS — A state appeals panel has affirmed dismissal of a workers’ compensation claim forfeited due to false statements.

On June 21, 2018, District Seven Workers Compensation Judge Shannon Bruno Bishop dismissed a claim from Ryan Lovas, a machinist for Turner Industries Group, who sustained a work-related injury in July 2016 when his firm was a subcontractor at the Phillips 66 Belle Chasse facility. Bishop found Lovas made a false statement to get benefits and also failed to truthfully complete a prior medical history questionnaire.

Lovas appealed that finding to the 4th Circuit Louisiana Court of Appeals. Judges Sandra Cabrina Jenkins, Rosemary Ledet and Dale Atkins heard arguments, and Jenkins wrote the opinion issued March 20.

On appeal, Lovas said Bishop erred in finding he committed fraud because Turner didn’t make a fraud allegation in its pretrial statement. The panel disagreed, finding Turner properly pleaded fraud in an answer to Lovas’ claim. Lovas also said Turner didn’t satisfy its burden of proving fraud, but the panel again disagreed.

“Lovas denied that he was ever treated for low back pain before the accident,” Jenkins wrote, an assertion contradicted in medical records introduced at trial, which showed he “sought treatment for chronic back pain at least five times,” including receiving “narcotic medication and intramuscular injections.”

The panel also noted failing to answer a questionnaire untruthfully doesn’t constitute fraud, but the employer must adequately give notice of the consequences of falsifying information.

“The notice on Turner’s questionnaire is in bold-faced, block lettering of no less than 10-point type,” Jenkins wrote. “It informs an employee/applicant who falsifies or misrepresents an answer on a medical questionnaire regarding pre-existing medical conditions that his claim for workers’ compensation benefits may be jeopardized. Thus, we find the notice provision in this case to be sufficient.”

The panel further said Turner met its obligation to demonstrate the untruthful answers on the questionnaire were related to the medical condition at the root of the claim because the company knew Lovas’ job as a machinist would require him to use his previously injured back.

Louisiana workers’ compensation laws have an anti-fraud forfeiture provision allowing employers to affirmatively defend against paying a claim and exposing violators to the possibility of restitution.

Lovas said he didn't violate that clause because any back treatment he received before the work injury “was inconsequential and not related to any injury,” according to Jenkins, in part because he never had operations. But the panel said Bishop’s written opinion fairly gave significant consideration to Lovas’ credibility.

“The record evinces discrepancies between Mr. Lovas’ medical records — which indicate that he has sustained injuries similar to the instant matter — and his trial and deposition testimony,” Jenkins wrote, noting Bishop could’ve determined Lovas understood the object of the health questionnaire and that he was able to deduce his back problems were in fact injuries that should’ve been disclosed.

As such, the panel affirmed Bishop’s finding that Lovas forfeited additional benefits.

Lovas is represented in the matter by the Law Office of Wolff & Wolff of Metairie.

Gallagher and Turner are represented by Taylor Wellons Politz & Duhe, APLC, of New Orleans.

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