Figueroa v. Hardtner Medical Center

• Decision Date: 25 January 2002
• Docket Number: No. 35,678-WCA.,35,678-WCA.
• Citation: 805 So.2d 1267
• Parties: Levita FIGUEROA, Plaintiff-Appellant, v. HARDTNER MEDICAL CENTER, Defendant-Aappellant.
• Court: Court of Appeal of Louisiana — District of US

805 So.2d 1267

Levita FIGUEROA, Plaintiff-Appellant, v. HARDTNER MEDICAL CENTER, Defendant-Aappellant.

No. 35,678-WCA.

Court of Appeal of Louisiana, Second Circuit.

January 25, 2002.

COPYRIGHT MATERIAL OMITTED

COPYRIGHT MATERIAL OMITTED

Stacy C. Auzenne, Alexandria, Counsel for Levita Figueroa.

John B. Saye, Monroe, Counsel for Hardtner Medical Center.

Before WILLIAMS, STEWART and CARAWAY, JJ.

CARAWAY, J.

The employer in this case terminated workers' compensation benefits to its former nurse, upon learning that the nurse was employed as a public school teacher. The employer claimed that false statements and representations were made by the employee, thereby requiring the forfeiture of benefits under La. R.S. 23:1208. The employee reconvened, requesting supplemental earnings benefits (SEBs), penalties and attorney's fees. The workers' compensation judge denied the employer's claim for forfeiture of benefits, but also denied the employee's claims. Both parties appeal the ruling. We now affirm the ruling regarding forfeiture and reverse the ruling which denied SEBs.

Facts

Claimant, Levita Figueroa ("Figueroa"), worked as a registered nurse for Hardtner Medical Center ("Hardtner"), a geriatric psychiatric hospital in Urania, Louisiana. On May 9, 1999, Figueroa was attacked by an Alzheimer's patient when she attempted to wake the patient to put him to bed. The patient grabbed Figueroa and hit her on the face and upper body, until an assistant managed to pull the patient off of her. Figueroa, who is right handed, suffered injuries to her right arm and right jaw. Figueroa claims that her injuries prevent her from performing her job duties: (1) preparing charts; (2) caring for mentally ill patients; and (3) bathing, feeding and/or lifting patients. Figueroa asserts that she has not regained strength in her right arm and has experienced mental problems as a result of being restricted from working as a nurse. Also, at the time of the accident, Figueroa was attending graduate school, studying to become a family nurse practitioner.

When doctors informed Figueroa that she could no longer work, she quit working at Hardtner in July 1999. Her testimony indicates that for the six-month period, January through June 1999, she earned approximately $18,000 as a Hardtner nurse. Figueroa then began receiving maximum wage benefits from Hardtner near the end of July 1999 in the amount of $359.48 per week. Nevertheless, in late August 1999, Figueroa accepted employment as a biology school teacher at Alexandria Senior High School. Figueroa testified that she received approximately $1500 per month as a teacher.

On March 10, 2000, Hardtner filed Louisiana Department of Labor Form 1008 to terminate Figueroa's workers' compensation benefits. Hardtner's Form 1008 alleges that Figueroa was engaged in employment at Alexandria Senior High School while receiving indemnity benefits, a violation of La. R.S. 23:1208. Figueroa filed an Answer to Form 1008 on June 20, 2000, denying any "false statements" and claiming that her benefits were arbitrarily terminated. Additionally, Figueroa argued that she was entitled to Supplemental Earnings Benefits (SEBs) under La. R.S. 23:1221(3)(a), because the wages she earned as a school teacher was less than ninety percent (90%) of her pre-injury wage. On September 13, 2000, Figueroa filed a Reconventional Demand against Hardtner, alleging that Hardtner's termination of benefits was arbitrary, capricious and without cause, that she was entitled to SEBs, and that Hardtner should pay all back due benefits, along with penalties and attorney's fees, plus interest from the date of termination of benefits.

Following trial, the Workers' Compensation Judge ("WCJ") rendered oral reasons for judgment and granted Figueroa's Motion for Directed Verdict, dismissing Hardtner's claim that Figueroa made false statements under La. R.S. 23:1208. Nevertheless, the WCJ also denied Figueroa's demand for SEBs, as well as her claim for penalties and attorney's fees for Hardtner's alleged unreasonable termination of benefits.

On appeal, both parties contest the WCJ's rulings.

Discussion

Factual findings in workers' compensation cases are subject to the manifest error or clearly wrong standard of appellate review. Hoy v. Gilbert, 98-1565 (La.3/2/99), 754 So.2d 207; Seal v. Gaylord Container Corporation, 97-0688 (La.12/2/97), 704 So.2d 1161; Banks v. Industrial Roofing & Sheet Metal Works, 96-2840 (La.7/1/97), 696 So.2d 551; Smith v. Louisiana Department of Corrections, 93-1305 (La.2/28/94), 633 So.2d 129; Freeman v. Poulan/Weed Eater, 93-1530 (La.1/14/94), 630 So.2d 733. In applying the manifest error/clearly wrong standard, the appellate court must determine not whether the trier of fact was right or wrong, but whether the fact finder's conclusion was a reasonable one. Seal, supra; Banks, supra; Freeman, supra,. Stobart v. State, 617 So.2d 880, 882 (La.1993). Where there are two permissible views of the evidence, a fact finder's choice between them can never be manifestly erroneous or clearly wrong. Seal, supra; Banks, supra; Stobart, supra. Thus, if the fact finder's findings are reasonable in light of the record reviewed in its entirety, the court of appeal may not reverse, even if convinced that had it been sitting as the trier of fact, it would have weighed the evidence differently. Seal, supra; Banks, supra.

Section 1208 Forfeiture

Hardtner's answer to the appeal asserts that Figueroa fraudulently obtained benefits through misrepresentations when she endorsed and cashed her indemnity checks, while simultaneously working at the high school. Also, Hardtner claims that Figueroa's failure to inform Hardtner or its claims adjuster of her change in work status constitutes fraud under La. R.S. 23:1208.

Forfeiture of workers' compensation benefits is governed by La. R.S. 23:1208, which provides in part: "It shall be unlawful for any person, for the purpose of obtaining or defeating any benefit or payment ... to willfully make a false statement or representation." Section 1208(E) provides the following remedy, among others, for an employee's fraudulent acts:

Any employee violating this Section shall, upon determination by workers' compensation judge, forfeit any right to compensation benefits under this Chapter.

Section 1208 is a broadly worded statute that applies to any false statements or representations, including those concerning prior injuries, and the employer need not show that it has been prejudiced as a condition of forfeiture. Hernandez v. ESKCO, Inc., 2000-0174 (La.App. 4th Cir.11/15/00), 773 So.2d 865, writ denied, 2000-3430 (La.2/9/01), 785 So.2d 824. The statute, which requires a worker to forfeit workers' compensation benefits for willfully making a false statement or misrepresentation to obtain benefits, is rationally related to the state's objective of promoting honest representations and full disclosure by claimants. Sumrall v. Luhr Bros., 95-0779 (La.App. 1st Cir.12/15/95), 665 So.2d 796, writ denied, 96-0187 (La.3/15/96), 669 So.2d 425.

La. R.S. 23:1208 allows for the forfeiture of benefits when proof is made that (1) there is a false statement or representation; (2) that is willfully made; and (3) is made for the purpose of obtaining or defeating any benefit or payment. Resweber v. Haroil Const. Co., 94-2708 (La.9/5/95), 660 So.2d 7; Smalley v. Integrity, Inc., 31,247 (La.App.2d Cir.12/9/98), 722 So.2d 332, writ denied, 99-0072 (La.3/19/99), 739 So.2d 782.

When a claimant does not receive the forms for reporting earnings, the employee should not be found guilty of La. R.S. 23:1208 fraud when working and receiving indemnity and medical benefits, since the employer never inquired about the employee's earnings while paying benefits. Smalley, supra. Until proper notice and forms are provided to the claimant, appellate courts have been reluctant to declare a claimant's failure to report income as fraudulent behavior. Louisiana Workers' Compensation Corp. v. Gray, 34,-731 (La.App.2d Cir.5/9/01), 786 So.2d 310, 316; Smalley, supra.

At trial, Figueroa claimed that she was not aware that working at a different job was impermissible while receiving workers' compensation benefits. Figueroa testified that she spoke with Hardtner's adjuster, Martha Walker, only on one occasion—June 24, 1999. At that time, Figueroa was still attempting to work for Hardtner. Figueroa denies that Walker explained that her entitlement to benefits would end upon her return to work. Figueroa had no further contact with Walker until her daughter received a call from Walker in January, 2000. During the January 2000 phone call, Figueroa's daughter informed Walker that her mother was at work. Upon learning that Figueroa was working, Walker told claimant's daughter that Figueroa committed fraud and would go to jail.

Figueroa claims that she never received any forms requesting information about her earnings or any information from Hardtner detailing her rights under the Workers' Compensation Act. She asserts that neither Walker nor anyone else ever asked her if she was working anywhere from September 1999 until the January 2000 phone call. Figueroa testified that had she known that it was improper to work and receive workers' compensation indemnity benefits, she would not have worked. She also testified that she never intended to misrepresent her work status.

Hardtner asserts that its evidence proved that Figueroa fraudulently obtained benefits. Hardtner points to Walker's deposition testimony, wherein Walker reviewed her handwritten note from the June 24, 1999 phone call. Walker's note stated: "Spoke with Ms. Figueroa, advised her of her rights under Workers' Comp. No. 1, two-thirds of her salary would be paid until such time as she is able to return to work; No. 2, medical paid 100 percent; No. 3, entitled to mileage 28 cents a mile." (Emphasis ours). Furthermore, Hardtner asserts that Figueroa received a letter dated December...