Key Issues in Misrepresentation
Under Florida’s Workers’ Compensation Laws, a claimant will have a heavy price to pay if an administrative hearing officer, court, or jury, finds the injured worker knowingly or intentionally made any false, fraudulent, or misleading statement, either verbally or in writing, to obtain any benefit under the workers' compensation law. The price a claimant pays for misrepresentation is quite substantial, as the claimant will lose all further entitlement to any benefits from his injury if he commits misrepresentation.
We just take a moment of your time to underscore the importance of record keeping by the employers in order to quickly shut down claimants that may be committing misrepresentation. While everyone hates performing and filing extra paperwork, in certain situations, this excess paper work can potentially save hundreds of thousands of dollars in workers’ compensation claims. Performing post-hire medical questionnaires, immediately reporting work accidents to the carrier, completely detailing reports regarding the work accident, and even taking recorded statements from the claimant immediately after the accident are just a few ways that may help decrease claim exposure. We highlight a recent case that deals with a claimant making misrepresentations regarding his workers’ compensation claim.
In THG Rentals & Sales of Clearwater, Inc. v. Arnold, No. 1D15-970, 2016 WL 1077278 (Fla. Dist. Ct. App. Mar. 17, 2016), the claimant suffered a compensable workers' compensation injury on August 6, 2013, injuring his back and right knee. The claimant then proceeded to file 5 petitions for benefits, requesting both indemnity and medical benefits for both of the injuries he received. The Employer/Carrier denied the claimant’s entitlement to benefits “based on misrepresentation.” By the time the parties met at the final hearing, the only benefits at issue were related to the claimant’s knee injury. At the hearing, the JCC ultimately rejected the misrepresentation defense as the alleged misrepresentation related only to the claimant’s back injury, but not his right knee injury, which was the injury in question at the hearing.
On appeal, the First District Court of Appeal found the JCC narrowly and improperly analyzed the misrepresentation defense by only making the determination of whether the misrepresentation was regarding the injury at issue. The court noted the “JCC apparently believed that to prove misrepresentation, the Employer/Carrier had to link the allegedly false statements directly to the particular injury and benefits being sought, to the claimant’s knee in this instance.” Id. at *1. The Court went on to note that §440.105 makes it illegal for a claimant to make “…any false, fraudulent, or misleading oral or written statement…” (emphasis added) and that §440.09(4)(a) states that benefits are barred for a claimant found to have “knowingly or intentionally engage in any of the acts described in s. 440.105 … for the purpose of securing workers’ compensation benefits…” (emphasis added). In summary, the Court concluded that as long as a claimant makes any misrepresentation for the purpose of obtaining benefits, all benefits are barred, not just the benefits received as a result of the claimant’s misrepresentations.
This is an important fact to note for employers. The misrepresentation defense can be used regarding any of the claimant's statements for the purpose of seeking any workers' compensation benefits. As an example, common misrepresentations made from claimants are false statements to their doctors about the severity of the injuries or false statements in depositions. The misrepresentations do not have to made under oath. The more records and details an employer can collect regarding the claimant’s accident will help to either confine the claim payouts to only the medical necessary treatment for the related injury or to quickly shut down the claim if the claimant has made any misrepresentations for the purpose of obtaining benefits.
If employers or carriers have any questions regarding what practices they can pursue in order to potentially limit their exposure for current and future workers’ compensation claims, please don’t hesitate to give us a call. We look forward to serving you.
Aaron T. McCurdy, Associate
amccurdy@mcconnaughhay.com
(850) 434-7122
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