Malcolm GRANT, PlaintiffAppellant,
v.
NATCHITOCHES MANOR NURSING HOME, DefendantAppellee.
Court of Appeal of Louisiana, Third Circuit.
*74 George Arthur Flournoy, Alexandria, for Malcolm Grant.
Claude Wilbur Bookter Jr., Shreveport, for Natchitoches Manor Nursing Home.
Before COOKS, SAUNDERS and BABINEAUX, JJ.
SAUNDERS, Judge.
Claimant appeals from a judgment of the Office of Workers' Compensation disqualifying him from receiving workers' compensation benefits based on violation of La.R.S. 23:1208, which governs misrepresеntation concerning benefits. For the following reasons, we reverse the finding of the hearing officer.
FACTS
On October 17, 1995, Malcolm Grant was employed at Natchitoches Manor Nursing Home as a nurse's assistant, when he slipped, fell and twisted his left knee. Grant reportеd the injury and the required forms were completed by the employer.
Grant then went to the Natchitoches Parish Hospital emergency room where he was diagnosed with having a left knee sprain. The report from the emergency room visit reflects that Grant gave a "history of injury to his knee in the past with swelling which is said to have persisted over a period of weeks."
Grant was then seen by an orthopaedic surgeon, Dr. John P. Sandifer, on October 18, 1995. Dr. Sandifer noted tenderness over the medial collateral ligament and рrescribed *75 medication as well as a knee sleeve to provide support to Grant's knee. On November 1, 1995, Dr. Sandifer became concerned that Grant had suffered a possible cartilage tear and scheduled an MRI of claimant's knee. An addendum tо this report by Dr. Sandifer states, "Mr. Grant has no significant history of prior knee injuries or problems. He was doing well prior to this injury." Following the MRI, Grant was diagnosed with an oblique tear on the medial meniscus.
Grant then went to Dr. Baer I. Rambach, an orthopaedic surgeon, for a sеcond opinion. He told Dr. Rambach that he had experienced continuing problems with knee popping, considerable pain and occasional swelling. Asked by Dr. Rambach about his medical history, Grant informed him of a fractured right ankle from playing foоtball in high school, a fractured wrist years ago, a ruptured spleen in 1988, and a splenectomy.
After noting the emergency room records at Natchitoches Parish Hospital and the history of a prior knee injury, defendant learned that Grant had seen a physiсian for left knee problems prior to the accident on October 17, 1995, prompting counsel for defendant to issue a subpoena duces tecum to Natchitoches Out-Patient Medical Center. These records indicated that Grant was seen on Seрtember 18, 1995, with an occasional popping to his left knee, tenderness over the medial collateral ligament and slight effusion. At the time, he was diagnosed with a left knee sprain.
On May 8, 1996, Grant's deposition in regard to this case was taken. Grant was asked several questions relating to his past condition and the accident to which he responded that prior to the accident he was perfectly healthy and had no prior problems with his left knee. Claimant further denied recalling going to any doctors prior to this injury, exсept for one physician he consulted for a cold.
At the hearing on the matter, Grant described the original account of the accident and admitted to a prior history of knee injury and indicated that the inaccurate statements made at his deрosition were errors in his recollection and that he did not intentionally lie or misrepresent any facts.
On May 8, 1996, the deposition of Dr. John Sandifer was also taken. In his deposition, Dr. Sandifer testified that Grant had informed him that he had no prior problems with his knee. However, in an affidavit dated August 9, 1996, Dr. Sandifer stated that there was no discussion between himself and Grant concerning a prior history of the left knee. Also, Dr. Sandifer stated in his affidavit that had he made an inquiry concerning Grant's prior history, he was certain Grant would have revealed the proper history.
The hearing officer found that Grant's inconsistent statements constituted violations of La.R.S. 23:1208 and disqualified him from receiving compensation benefits. It is from this judgment that Grant appeals.
LAW AND OPINION
On appeal, Grant contends the hearing officer erred in disquаlifying him under the provisions of La.R.S. 23:1208.
In Resweber v. Haroil Const. Co., 94-2708, 94-3138 (La.9/5/95);660 So.2d 7 , the supreme court noted that in order to forfeit benefits, La.R.S. 23:1208 requires that 1) there is a false statement, 2) it is willfully made, and 3) it is made for the purpose of obtaining or defeating any benefit or payment.
In reviewing determinations of the heаring officer, the standard of review is the manifest error or clearly wrong standard. Alexander v. Pellerin Marble & Granite, 93-1698 (La.1/14/94);630 So.2d 706 . However, this court has a constitutional duty to review facts. Ambrose v. New Orleans Police Dep't Ambulance Serv., 93-3099, 93-3110, 93-3112 (La.7/5/94);639 So.2d 216 .
Sumner v. Lake Charles Marine, 96-280, p. 3-4 (La.App. 3 Cir. 6/5/96);
After reviewing the facts of the present case, it is evident that the hearing officer was correct in determining that Grant hаd made a false statement. His testimony at trial and his testimony in his deposition directly conflict. However, it is not as evident that the statements were willfully made.
*76 The word "willful" has been defined as proceeding from a conscious motion of the will; voluntary; knowingly; deliberate; intending the result which actually comes to pass; designed; intentional; purposeful; not accidental or involuntary. Black's Law Dictionary 1599 (6th ed. 1990).
When Grant first reported his accident to the emergency room, he fully disclosed the pain and discomfort he was experiencing and spеcifically indicated that he had a prior history concerning an injury to his left knee. Grant testified that the discrepancy given in his deposition as to previous medical care concerning his knee was not done intentionally. After reviewing the record in its entirety, we find the hearing officer erred in concluding that the false statements were willfully made, as the record suggests they were made thoughtlessly and inadvertently.
Next, we turn to the hearing officer's determination that Grant's statements were made for the purpose of оbtaining compensation benefits. As previously mentioned, while there is an inconsistency in Grant's deposition, he clearly reported his injury to the treating physician at the emergency room concerning his left knee. The medical testimony indicated that Grant did in fact suffer a work-related injury and was already in receipt of benefits at the time the false statements were made. These facts do not support a finding that Grant's statements were made for the purpose of obtaining compensation benefits. Acсordingly, the judgment of the hearing officer is hereby reversed.
Wholly apart from the substantive errors made by the hearing officer, on our own motion, we notice the want of the lower tribunal's subject matter jurisdiction as it pertains to a claim for forfeiture of benefits as provided for in La.R.S. 23:1208.
Jurisdiction is the legal power and authority of a court to hear and determine an action or proceeding involving the legal relations of the parties, and to grant the relief to which they are entitled. La.Code Civ.P. art. 1. Subject matter jurisdiction is the legal power and authority of a court to hear and determine a particular class of actions or proceedings, based upon the object of demand, the amount in dispute, or the value of the right asserted. La.Code Civ.P. art. 2. A judgment rendered by a court which has no jurisdiction over the subject matter of the action or proceeding is void. La.Code Civ.P. art. 3. Unlike other exceptions, the exception of subject matter jurisdiction is an issue that cannot be waived or conferred by the consent of the parties. Tran v. Schwegmann's Giant Super Market.,
Effective November 7, 1990, La. Const. art. V, § 16 was amended to provide for original jurisdiction of all civil and criminal matters in district courts, except as otherwise authorized by the constitution or "except as heretofore or hereafter provided by law for administrative agency determinations in worker's compensation matters." Sampson v. Wendy's Management, Inc.,
La.R.S. 23:1208, the provision upon which the hearing officer relied, provides in pertinent part:
§ 1208 Misrepresentations concerning benefit payments; penalty; civil immunity
A. It shall be unlawful for any person, for the purpose of obtaining or defeating any benefit or payment under the provisions of this Chapter, either for himself or for any *77 other person, to willfully make a false statement or representation
....
E. Any employee violating this section shall, upon dеtermination by hearing officer, forfeit any right to compensation benefits under this Chapter.
In Resweber v. Haroil Const. Co., 94-2708, p. 7 (La.9/5/95);
Section 1208 is clear and unambiguous and as such will be applied as written. La.Civ.Code art. 9; La.R.S. 1:4. Section 1208 clearly applies to any willful false statements or representations made "for the purpose of obtaining or defeating any benefit or payment." Seсtion 1208 has no language limiting it to only certain types of false statements, i.e., statements other than those relating to prior injuries.
Resweber v. Haroil,
The claim itself is not contingent upon whether a potential claimant falls within the ambit of the workers' compensation act (is injured by an accident during the course and scope оf his employment), or is based on the merits of the claim before the hearing officer, is strictly concerned with any misrepresentation made by a claimant.
Thus, it appears that when an employee violates La.R.S. 23:1208, his actions are tortious in nature (the conduct may even be considered criminal in nature), rather than a workers compensation matter. At best, the conduct prohibited by La.R.S. 23:1208 presents a cause of action in tort for fraud or deceit.
In Devore v. Hobart Mfg. Co.,
"Fraud exists if it can be shown that material misrepresentations have been made by one party designed to deceive another, ... to cause loss or inconvenience to the other."
Deville v. Leonards,
In Coleman v. Sheraton Pierremont, 25,452 (La.App. 2 Cir. 1/19/94);
DECREE
Accordingly, we find that the hearing officer erred in disqualifying claimant from receiving workers' compensation benefits based on a violation of La.R.S. 23:1208 as the record does not support a disqualification. Moreover, the hearing officer lacked subject matter jurisdiction to hear an action thаt is clearly tortious in nature.
We therefore reverse the judgment of the hearing officer and remand the case for further proceedings consistent herewith.
REVERSED AND REMANDED.
NOTES
Notes
[1] Additionally, Louisiana Courts have recognized a cause of action for negligent misrepresentation on behalf of a party as encompassed within La. Code Civ. P. art. 2315 and 2316:
The circumstances which must exist for the doctrine to apply are these: (1) there must be a legal duty on the part of the defendant to correctly supply information; (2) there must be a breach of that duty; and (3) the breach must have caused damages to the plaintiff. Pastor v. Lafayette Bldg. Ass'n.,
Cagle v. Loyd,