Winning a Workers' Comp Stare Down

A truck driver and his employer do not see eye to eye over a corneal injury. Is the worker a "total fake," or does he deserve compensation?

A truck driver received a minor abrasion to the cornea of his right eye when drilling mud splashed under his goggles. An optometrist treated him and released him to restricted duty for two days. The driver continued to complain of pain. He received treatment and medical releases to return to full duty from several doctors, but the driver failed to return to work for more than one month. A neuro-ophthalmologist concluded that the driver was malingering and described him as "a total fake." The employer subsequently terminated him for absenteeism.

The driver was denied unemployment benefits by an administrative law judge. The driver then filed for workers' compensation benefits, alleging that he was also entitled to penalties and attorney's fees.

The employer did not contest that the driver sustained a work-related abrasion to his eye. The employer argued that the medical evidence showed the abrasion healed quickly and the driver's complaints were related to a preexisting condition for which he made false statements in order to obtain benefits.

Medical records showed that the driver visited an eye doctor four times in the weeks immediately prior to the alleged incident with similar eye complaints, including blurred vision, eye pain and throbbing. The last time he visited the eye doctor was two days before the incident.

In his deposition, the driver stated that he only visited an eye doctor once since he was hired by the employer. The driver also denied having previous eye problems. The driver asserted that he did not understand the deposition question due to his diminished mental capacity. The driver submitted proof that he did not receive a high school diploma but a diploma for an alternative program of study.

The trial court denied benefits to the driver, finding that he made false statements for the purpose of obtaining workers' compensation benefits.

Was the trial court correct in denying benefits for the driver's eye injury?

A. No. The driver's diminished mental capacity excused his false statement in his deposition.

B. No. The driver's preexisting eye problems were aggravated by the abrasion he sustained at work.

C. Yes. The evidence showed that the driver had pre-existing eye problems, which were not connected to the work incident.

How the court ruled: C.

The Louisiana Court of Appeal held that the worker was not entitled to benefits. Johnson v. Pinnergy, Ltd., No. 46,188-WCA (La. Ct. App. 04/13/11).

The court explained that penalties, including a forfeiture of benefits, can be imposed for making a false representation in connection with a workers' compensation claim. The court agreed with the trial court that the driver intentionally made false statements regarding his prior eye symptoms and prior medical treatment.

A is incorrect. The court explained that there was no evidence that the driver suffered from diminished mental capacity. No evidence showed that the diploma he submitted indicated that he was a special education student.

B is incorrect. The driver did not show his symptoms were aggravated by the work incident. The court pointed out that the driver had similar eye complaints before and after the work-related incident.

CHRISTINA DIFONTE is the legal editor of the WorkersComp Forum.

This feature is not intended as instructional material or to replace legal advice.

Read more at the WorkersComp Forum homepage.

View the original article here