Court: Louisiana Court of Appeal; January 4, 2017; Louisiana; State Appellate Court
In the workers’ compensation case involving Mr. Todd Porche, the Office of Workers’ Compensation Administration (OWCA) denied his claim for reinstatement of benefits following an appeal. Mr. Porche sustained injuries from a fall while working as a derrick hand for Guichard Operating Co. LLC, with benefits initially provided from September 11, 2013, to March 13, 2014. Subsequently, Guichard and its insurer, The Gray Insurance Company, disputed Mr. Porche's claims, alleging he violated Louisiana statutes regarding misrepresentation, which led to the termination of his benefits. Mr. Porche countered with claims of wrongful termination of benefits and denial of recommended surgery, resulting in a consolidated trial. After a four-day trial, the workers’ compensation judge ruled against both parties on August 12, 2015. Mr. Porche's subsequent motion to reopen the case was denied on October 6, 2015, leading him to appeal on grounds of error regarding the denial of new evidence and the burden of proof for his injury. Guichard and Gray also appealed, asserting errors in the judge's findings related to Mr. Porche's alleged misrepresentations. The appellate court applied a manifest error standard for reviewing factual findings, emphasizing that reasonable conclusions by the fact finder cannot be deemed clearly wrong, even if the appellate court might have reached a different conclusion.
The workers’ compensation judge possesses significant discretion in evaluating expert testimony, which is treated like any other evidence. The judge may accept or reject expert opinions based on the totality of evidence presented at trial. When the judge's factual determinations hinge on credibility assessments, the manifest error standard of review affords substantial deference to the judge's findings.
In Mr. Porche’s second assignment of error, he contended that the judge erred in ruling that he failed to demonstrate that his work accident caused his disability. The judge concluded that the September 11, 2013, accident resulted in a head laceration and soft tissue injury, but the T-12 vertebrae fracture he claimed was pre-existing and not aggravated by the accident. The judge noted that muscle and ligament injuries had resolved by March 13, 2014, and any ongoing disability stemmed from Mr. Porche’s prior conditions, citing eleven accidents from 1995 to 2013—two work-related and eight motor vehicle accidents.
Dr. Christopher Cenac, the independent medical examiner, asserted that Mr. Porche’s issues predated the work accident and were unrelated to it. Mr. Porche did not present a countering medical expert. The judge found that the timing of Mr. Porche’s prior car accident in March 2013, just before the September accident, negated a presumption of causation. The evidence reviewed confirmed that Mr. Porche did not establish that his back fracture and related disability were caused by the work incident. Consequently, Mr. Porche’s second assignment of error was deemed without merit.
Guichard and Gray contested the workers’ compensation judge’s ruling that Mr. Porche did not violate La. R.S. 23:1208 and 1208.1 regarding false statements made to obtain benefits. Under La. R.S. 23:1208, an employee forfeits compensation benefits for making willful false statements to any party involved in the benefits process. The employer must prove all elements of the statute, as failure to establish even one element undermines their case. The burden of proof is high, requiring evidence of intentional misrepresentation rather than mere inconsistencies.
The workers’ compensation judge determined that Mr. Porche did not willfully misrepresent his earnings from selling scrap metal post-accident due to his intellectual limitations and lack of understanding of the statute. Although Mr. Porche provided a false statement during his deposition regarding his scrap metal sales, the crucial issue was whether this statement was made to obtain or defeat benefits. La. R.S. 23:1208(G) mandates employees receiving benefits for over 30 days to report other earnings to their employer. Mr. Porche complied with this requirement by submitting a report, which defined "wages" as payments for services, while "earnings" encompasses a broader range, including the sale of goods.
Thus, the court found that Mr. Porche's sale of scrap metal did not constitute a violation of La. R.S. 23:1208, as the signed reporting form focused on wages, and the statute discussed earnings, leading to ambiguity in interpretation.
Guichard and Gray's first assignment of error regarding the workers’ compensation judge's finding that Mr. Porche did not violate La. R.S. 23:1208 by presenting an incomplete medical history is dismissed as lacking merit. The judge determined that Mr. Porche did not misrepresent his medical history at Terrebonne General Medical Center due to trauma from a fall and noted that Dr. Cenac had access to Mr. Porche’s medical records. Dr. Cenac confirmed awareness of Mr. Porche's prior medical history, including nine previous accidents. The judge’s findings on this matter were not deemed manifestly erroneous.
The second assignment of error, which challenges the finding related to La. R.S. 23:1208.1 concerning Mr. Porche’s failure to fully disclose his medical history on job application forms, also lacks merit. Testimony from Ms. Deborah Hanks indicated that Mr. Porche was hired without completing the second injury questionnaire and that he relied on his wife to fill out the application. Additionally, Mr. Porche's sporadic employment history with Guichard provided the employer with knowledge of his physical condition.
Guichard and Gray argued they were prejudiced by Mr. Porche's incomplete disclosures, affecting their ability to obtain reimbursement from the second injury fund, and asserted that Mr. Porche had a pre-existing condition relevant to their claim. They also questioned the credibility of the Porches' testimony regarding the application process, citing inconsistencies.
La. R.S. 23:1208.1 outlines that a claimant may forfeit benefits for false statements about prior injuries if these statements are directly related to the medical condition for which benefits are sought and if the employer has provided notice of potential forfeiture. The employer bears the burden to prove these elements.
Forfeiture by the employer under La. R.S. 23:1208.1 requires specific 'prejudice' as defined by statute. The 'prejudice to the employer' test has two prongs: the first prong establishes a direct relation if the subsequent injury was inevitable due to a pre-existing condition, while the second prong, concerning 'merger,' requires proof that a permanent partial disability combined with the injury to result in a greater disability. Guichard and Gray's arguments focus on Mr. Porche's inability to complete medical history forms due to his and his wife's limited literacy. Mr. Porche had a history of educational struggles, scoring at a second-grade reading level, and testified he could not read a newspaper. His wife also struggled with reading and relied on assistance for applications. Despite claims of oversight by Ms. Hanks during the hiring process, her testimony indicated she assumed Mr. Porche understood the questions on the forms. Guichard and Gray failed to establish prejudice caused by Mr. Porche's non-disclosure of prior injuries; Dr. Cenac's testimony, suggesting that a prior injury could worsen outcomes, did not meet the employer's burden of proof. Thus, the court upheld the workers’ compensation judge’s ruling that Guichard and Gray were not entitled to penalties, as it was supported by the record and not manifestly erroneous.
Guichard and Gray argue that the workers’ compensation judge improperly required the parties to bear their own costs, citing La. R.S. 23:1317(B) which grants the judge discretion in such matters. The ruling was upheld as neither party prevailed on their claims. Mr. Porche claims the judge erred by not allowing him to reopen the record to present additional evidence regarding a surgery he underwent in 2015, which he argued was unforeseen. The court found no abuse of discretion in the refusal since the surgery had been previously recommended, and Mr. Porche failed to demonstrate that the new evidence would significantly impact the case. The appeal judgment was affirmed, with costs split evenly between Todd Porche and the Guichard Operating Company and The Gray Insurance Company. Relevant statutes highlighted include La. R.S. 23:1208 and 23:1208.1, which address penalties for false statements in workers’ compensation claims, and the conditions under which causation may be presumed. Additionally, information concerning the legalities of working while receiving workers' compensation benefits was reiterated.
Dr. Joni Claville, who treated Mr. Porche, noted in her testimony that he was awake and alert, contradicting the medical records which indicated "lost consciousness" as an associated symptom and described Mr. Porche's history as "unreliable" concerning potential head injuries. Dr. Cenac corroborated this by stating Mr. Porche described a "kind of blacked out" experience during his fall. Dr. Cenac's report highlighted Mr. Porche's complex medical history, including two motor vehicle accidents in 2013 and longstanding back and neck issues since 1995. Mr. Porche claimed Dr. Cenac had access to all his medical records during an independent examination.
The workers' compensation judge evaluated whether Mr. Porche breached La. R.S. 23:1208 while completing a post-hire medical questionnaire and concluded he did not, citing his lack of recollection regarding prior injuries and the circumstances under which he filled out the form. The judge referenced the Louisiana Supreme Court's ruling in Resweber v. Haroil Const. Co., clarifying that La. R.S. 23:1208.1 pertains to false statements on employment-related inquiries, not pending claims under La. R.S. 23:1208.
In addition to the application dated July 29, 2013, prior applications from Guichard dated October 3, 2006, July 29, 2011, and January 25, 2012 were submitted, with the 2011 and 2012 questionnaires leaving a critical question unanswered. The 2006 application, completed by Mrs. Porche, noted a previous "hernia repair." The case was differentiated from Dulin v. Levis Mitsubishi, Inc., where the court found a violation of La. R.S. 23:1208.1, citing the presumption that individuals signing contracts are aware of their contents. The workers’ compensation judge accepted the Porches' testimony regarding an assurance that not all doctors and muscle strains needed to be listed. Lastly, La. R.S. 23:1317(B) grants discretion to the workers’ compensation judge to award costs, which may be taxed like other civil proceedings.
