Opinion
2021 CA 1528
07-05-2022
SHELL CHEMICALS GEISMAR, Tristar Risk Management v. Grant WALKER
Mark G. Montiel, Jr., Michael E. Johnson, Jr., Maxwell A. Malvin, New Orleans, Louisiana, Attorneys for Appellant Shell Chemicals Geismar LP Robert Glueck, Baton Rouge, Louisiana, Attorney for Appellee Grant Walker
Mark G. Montiel, Jr., Michael E. Johnson, Jr., Maxwell A. Malvin, New Orleans, Louisiana, Attorneys for Appellant Shell Chemicals Geismar LP
Robert Glueck, Baton Rouge, Louisiana, Attorney for Appellee Grant Walker
BEFORE: GUIDRY, HOLDRIDGE, AND CHUTZ, JJ.
HOLDRIDGE, J.
Shell Chemicals Geismar, LP (Shell) appeals a judgment by the Office of Workers’ Compensation (OWC) dismissing its claim for restitution of workers’ compensation benefits pursuant to the Louisiana Workers’ Compensation Fraud Statute, La. R.S. 23:1208. We affirm.
BACKGROUND
On June 4, 2019, Grant Walker filed a claim for workers’ compensation benefits against Shell in the OWC. Therein, he claimed that on the evening of March 29, 2018, he tripped over a pipe while working at Shell's Geismar facility, entered a backed-up tanker, and fell on his back. It is undisputed that Mr. Walker was employed by Shell on the date of the accident. It is further undisputed that Mr. Walker was paid indemnity benefits at the maximum indemnity rate from April 2, 2018, through May 19, 2019, and received medical benefits from March 29, 2018, through January 7, 2020, following the accident.
On January 7, 2020, Shell notified Mr. Walker that compensation benefits were being terminated on the basis that Mr. Walker's treating physician, Dr. Henry Eiserloh, III, opined that Mr. Walker temporarily exacerbated his pre-existing lumbar injury in the work accident, which resolved no more than six months after the accident. Later that month, Shell filed a reconventional demand against Mr. Walker, asserting that he forfeited any right to benefits he may have been entitled to by making false statements for the purpose of obtaining benefits in violation of La. R.S. 23:1208.
Thereafter, on February 10, 2020, Shell filed a motion for summary judgment, urging that Mr. Walker received all compensation benefits to which he was entitled and forfeited any right to further compensation benefits by willfully making multiple false statements and representations for the purpose of obtaining benefits in his deposition, in discovery responses, and to Dr. Eiserloh, who treated Mr. Walker following the accident. On July 15, 2020, the Workers’ Compensation Judge signed a judgment granting Shell's motion in part and denying the motion in part. The WCJ ruled that Shell met all of its responsibilities with respect to indemnity and medical benefits owed to Mr. Walker arising from the work accident and dismissed Mr. Walker's claim for additional benefits arising from the March 29, 2018 accident. The WCJ denied Shell's motion for summary judgment on the fraud issue.
In written reasons for judgment following the trial on Shell's reconventional demand, the WCJ expressly found that Mr. Walker was not entitled to additional compensation benefits because the aggravation of his pre-existing back condition caused by the work accident had resolved and Mr. Walker's current complaints of back pain were no longer related to the accident.
Trial proceeded on Shell's reconventional demand. Shell attempted to demonstrate that Mr. Walker made misstatements regarding extensive medical treatments he received for his pre-existing back condition for the purpose of obtaining workers’ compensation benefits. During the trial, Mr. Walker testified and voluminous documentary evidence was entered into the record.
On July 30, 2021, the WCJ signed a judgment finding that Mr. Walker did not violate La. R.S. 23:1208, did not forfeit his benefits, and did not owe restitution to Shell. In making this finding, the WCJ specifically found that Mr. Walker's testimony was credible. The WCJ considered each of the bases upon which Shell's restitution demand rested and rejected them, ultimately finding that Mr. Walker did not willfully make false statements regarding his prior back condition in order to obtain compensation benefits. The WCJ found as a fact that Mr. Walker notified Dr. Eiserloh of his prior back issue and also disclosed his pre-existing back condition during his deposition. The WCJ stressed that while Mr. Walker's responses may not have been as detailed as Shell would have liked, Mr. Walker never denied having a pre-existing back condition. The WCJ also accepted Mr. Walker's attorney's explanation that he answered an interrogatory regarding prior medical treatment for Mr. Walker's back condition in error.
In this appeal, Shell contends that the WCJ committed reversible error in concluding that Mr. Walker did not commit fraud under La. R.S. 23:1208. We disagree.
Louisiana Revised Statute 23:1208A provides that it shall be unlawful for any person, for the purpose of obtaining workers’ compensation benefits, to willfully make a false statement or representation. An employee violating this provision shall forfeit any right to workers’ compensation benefits. La. R.S. 23:1208E. The three requirements for forfeiture of the right to workers’ compensation benefits under Section 1208 are: (1) there is a false statement or representation; (2) it is willfully made; and (3) it is made for the purpose of obtaining compensation benefits. Our Lady of the Lake Regional Medical Center v. Mire, 2013-1051 (La. App. 1st Cir. 2/18/14), 142 So.3d 52, 56. Because forfeiture of workers’ compensation benefits is a harsh remedy, statutory forfeiture must be strictly construed. Id. Thus, an employer has the burden of proving each element within the statute, and the lack of any one of the elements is fatal to an employer's avoidance of liability. Id.
The issue of whether an allegedly false statement or misrepresentation by the employee requires forfeiture of workers’ compensation benefits pursuant to Section 1208 is a question of fact, governed by the manifest error standard of review on appeal. Id. Under that standard of review, in order to reverse the WCJ's finding that Mr. Walker did not violate Section 1208, this court must find that a reasonable factual basis does not exist for the WCJ's ruling and that the finding is clearly wrong or manifestly erroneous. See Stobart v. Louisiana Department of Transportation and Development, 617 So.2d 880, 882 (La. 1993). Where the findings are based on determinations regarding the credibility of a witness, the manifest error-clearly wrong standard demands great deference to the trier of fact's findings. Rosell v. ESCO, 549 So.2d 840, 844 (La. 1989). On appeal, the issue to be resolved by this court is not whether the WCJ's ruling is right or wrong, but whether that ruling is a reasonable one. Our Lady of the Lake Regional Medical Center, 142 So.3d at 56. If the WCJ's findings are reasonable in light of the record reviewed in its entirety, the court of appeal may not reverse even though convinced that, had it been sitting as the trier of fact, it would have weighed the evidence differently. Stupp Bros., Inc. v. Alexander, 2017-1151 (La. App. 1st Cir. 2/20/18), 243 So.3d 22, 35.
In finding that Shell failed to prove that Mr. Walker willfully made false statements for the purpose of obtaining compensation benefits, the WCJ weighed the evidence and made a credibility determination. Although another fact finder may have made a different credibility determination and weighed the evidence differently, we find the WCJ's factual conclusion that Mr. Walker did not violate Section 1208 is not manifestly erroneous or clearly wrong. See Stupp Bros., Inc., 243 So.3d at 37. Therefore, we may not disturb that ruling.
For the foregoing reasons, the judgment appealed from is affirmed. All costs of this appeal are assessed appellant, Shell Chemicals Geismar LP.