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Contents of Main Volume | Contents of Supplement
DISCLAIMER: The Longshore Benchbook was created solely to assist the Office of Administrative Law Judges as a first reference in researching cases arising under the Longshore and Harbor Workers' Compensation Act, and extension acts, as amended. This Benchbook does not constitute the official opinion of the Department of Labor, the Office of Administrative Law Judges, or any individual judge on any subject. This Benchbook does not necessarily contain an exhaustive or current treatment of case holdings, and should, under no circumstances, substitute for a party's own research into the statutory, regulatory, and case law authorities on any given subject referred to therein. It is intended to be used as a research tool, not as final legal authority and should not be cited or relied upon as such.
PDF Version: Volume I (Topics 1-21) | Volume II (Topics 22-90)
Description |
Topic |
Penalty for Misrepresenting -- Prosecution of Claims |
31 |
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31.1 |
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31.2 |
TOPIC 31
Topic 31
Generally
[ED. NOTE: The following is provided for
informational value only.]
St. Bernard Parish Police Jury and Travelers Property
Casualty Corp. v. Duplessis, 831 So. 2d 955 (La. Supreme Ct. 2002).
The Louisiana State Supreme Court held that a claimant's willful
misrepresentation of mileage reimbursement subjected him to the forfeiture of
his workers' compensation benefits, pursuant to LSA-R.S. 23:1208. The statute,
in pertinent parts, states that it is unlawful for any person, for the purpose
of obtaining or defeating any workers' compensation benefit or payment, to
willfully make a false statement or representation. "Any employee
violating this Section shall, upon determination by workers' compensation
judge, forfeit any right to compensation benefits under this Chapter."
Claimant had submitted a request for reimbursement for 4,354 miles when he was
only entitled to 1,114.2 miles for doctors' visits.
Although noting that the claimant was "not a workers' compensation
neophyte," the hearing officer, found that the forfeiture of all benefits
was "too harsh" and ordered the forfeiture of the requested mileage
and referral of the matter to the Fraud Section. On appeal the court affirmed
the ruling. Noting the intent of the state legislature, the Louisiana State
Supreme Court has now overturned the prior rulings and denied all future
benefits.
Topic 31.2 Penalty
For Misrepresentation--Prosecution of Claims--Claimant's Conduct
[ED. Note: The following case is included for
informational value only.]
United States of America v. Somsamouth,
F.3d (Nos. 02-50453 and 02-50461)(9th Cir.
Dec. 18, 2003).
This is an unsuccessful appeal of a husband and wife's convictions for making
false representations of material facts to the Social Security Administration
for the purpose of retaining Supplemental Security Income benefits. The couple
challenged the convictions on the grounds that the term "work" was
not defined for the jury in the jury instructions. They also argue that their
statements about working were not materially false.
The Ninth Circuit found that the "simple word"
"work" needed no jury instruction definition: "We start with the
obvious, almost banal proposition that the district court cannot be expected to
define the common words of everyday life for the jury." "[W]ork is
not an arcane concept in this context, and there was no need for the district
court to define it further. If the court had defined it and done so correctly,
that would not have been helpful to [the couple]." They had argued that
the average person might believe that "work" does not necessarily
require substantial gainful activity of the sort that generates wages or other
economic benefits." The Ninth Circuit found that if the average
person believed this, the average person was correct. The court noted that
during the interview process, the couple was asked if they did any work,
including volunteer work.
Next the couple argued that their falsehoods about work cannot have been
material because it has not been shown that their working was also substantial
gainful activity. The Ninth Circuit stated that "In so arguing,
they ask us to take an overly crabbed view of materiality." The court
noted that it has previously addressed the meaning of the general statute
covering false statements of ‘material fact' to government agencies and have
defined the concept as follows-- "A statement is considered material if it
has the propensity to influence agency action; actual influence on agency
action is not an element of the crime."
The Ninth Circuit explained that the issue was not whether the couple
was performing substantial gainful activity; it was whether their false
statements had a propensity to influence agency action. "Even if the
extensive work activities in which the [couple] were engaged were not actually
generating income for them, it is pellucid that truthful answers to the SSA's
questions about their activities would have led to further investigation at
least. [Their] lies were designed to influence the agency into not
investigating them or giving further consideration to whether they were, in
fact, engaging in substantial gainful activities." Importantly, the court
noted that had the agency known they were doing some work, even if not
"gainful," the agency would have inquired into their capabilities to
do further work, rendering them not disabled.
Topic 31.2 Penalty For
Misrepresentation–Prosecution of Claims–Claimant’s Conduct
A-Z International v. Phillips, 323 F.3d 1141 (9th
Cir. 2003).
Section 27(b) of the LHWCA does not authorize a federal district court to
sanction a claimant for contempt for filing a false claim for benefits under the
LHWCA. The term “lawful process” is not broad enough to include the
filing of a complaint that misrepresents the jurisdictional facts. The Ninth
Circuit found that in enacting the LHWCA, Congress expressly provided
mechanisms other than contempt sanctions to deal with fraudulent claims before
an ALJ. “In interpreting a statute, courts must consider Congress’s words
in context “with a view to their place in the overall statutory scheme.” Citing
Davis v. Mich. Dep’t of Treasury, 489 U.S. 803, 809 (1989).
The Ninth Circuit went on to note, “The LHWCA has specific provisions
that deal with fraud before the ALJ, such as 33 U.S.C. §§ 931(a) and 948.
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