Wednesday, November 01, 2017

Pearson Ford v. WCAB (Cal. Ct. App. - Nov. 1, 2017)

You occasionally see public service advertisements against workers' compensation fraud around town and on television.  There's even a billboard right down the street from my office that essentially looks like this one:

Which is pretty neat.  I'm not sure these things are at all effective -- if they did, maybe we should put up signs that make similar exhortations not to commit murder -- but it at least reflects a claim that we take these types of cases seriously.

Commit Workers' Comp Fraud, Go To Jail.


Though then there are opinions like today's.  Which, like the billboard and advertisement above, all come out of San Diego.  And which, if you had to summarize in a motto, would probably read:

Commit Workers' Comp Fraud, Get a Slap On The Wrist.  Then Get More Workers' Comp Benefits.

A motto that's probably not an especially effective deterrent.

It's a neat little case:

"On March 24, 2006, while working at Pearson Ford, Leopoldo Hernandez accidentally slammed the trunk of a car on his left hand and crushed one of his fingers. Although no bones in his hand were broken, he was unable to continue working at Pearson Ford because of continuing pain in his hand and shoulder. Hernandez applied for and received workers' compensation benefits.

From 2006 through 2010, Hernandez was treated and examined by a number of physicians for severe pain related to his injury and with respect to his workers' compensation claim. . . .

The parties designated Dr. Byron F. King, an orthopedic specialist as an agreed medical examiner (AME). Dr. King examined Hernandez on March 31, 2009. Hernandez required the assistance of a Spanish-speaking interpreter. Dr. King had some difficulty in examining Hernandez's left arm and hand; in particular, although Hernandez complained about his inability to use his left hand and arm, he would not permit Dr. King to perform grip or pinch strength tests on the hand. In his March 31, 2009 report, Dr. King stated that Hernandez presented "a very difficult diagnostic dilemma in that he does not appear to make any effort to cooperate with requests for left upper extremity use activities." Dr. King also noted that the condition of the soft tissue on Hernandez left hand was not consistent with Hernandez's total lack of use of it, which Dr. King observed during the examination."

Well, okay.  Maybe the guy was faking it, so didn't want an incredibly detailed examination.  But just maybe he didn't want a stranger poking around a hand that totally hurt.  Tough to say.

So let's see . . . .

"Some months after Dr. King's examination, between January 11, 2010, and May 5, 2010, Hernandez was examined three times by Dr. Walter Strauser. Dr. Strauser is a pain specialist and had been treating Hernandez. Dr. Strauser prescribed a number of medications for Hernandez, including opiates. On each of his visits to Dr. Strauser, Hernandez wore a sling on his left arm and complained of continuing severe pain and an inability to use his left arm and hand.  After each examination, Dr. Strauser continued to provide Hernandez with pain medication, including an opiate.

Pearson Ford's workers' compensation carrier retained the services of a private investigator, who conducted video surveillance of Hernandez following each of the three visits to Dr. Strauser in early 2010. Following each visit, Hernandez was observed taking off his sling, using his left hand to get in and out of his truck or a car, using his left hand to steer his truck or car, and on one occasion stopping at a grocery store and using his left hand to carry a bag of groceries.

During the period Hernandez's visits to Dr. Strauser were being surveilled, he also had one appointment, on February 18, 2010, with an orthopedist, who specialized in treatment of the arms and hands, Dr. Greg M. Balourdas. Dr. Balourdas was acting as Hernandez's primary physician and working with Dr. Strauser in providing care for Hernandez. As he did when he was examined by Dr. Strauser, Hernandez appeared at his appointment with Dr. Balourdas wearing a sling on his left arm. . . .

Following his visit to Dr. Balourdas, Hernandez was observed once again taking off his sling, driving his car and stopping at an appliance store where, using both hands, he lifted a washing machine into the back of the car he was driving. "

Okay, then.  That may provide some helpful explanatory context.

So Hernandez gets prosecuted for workers' compensation fraud.  He pleads guilty.  And he's sentenced to (1) 90 days of summary probation, and (2) repaying $9000 in benefits he obtained.

Not exactly "Commit Fraud, Go to Jail".

But then guess what?  Hernandez continues to say, despite the fraud conviction, that his hand still really doesn't work, and continues to ask for benefits.  And the Court of Appeal agrees.  The fact that he's been convicted of fraud for this exact injury doesn't deprive him of the right to get benefits if he can prove that, despite his criminal fraud, he's still a "little bit" injured (although not in the way that he previously defrauded people).

I'm not saying that's right or wrong.  You can see why the Court of Appeal might come out that way.

But such a result definitely gives new meaning to the slogan "Commit Workers' Comp Fraud, Get a New Outfit."  Cause the "new outfit" Hernandez got wasn't a jail uniform.  At all.  That new outfit was instead probably a nice new suit -- or at least an attractive set of sweatpants.  All paid for by his brand new workers' comp benefits.  Benefits he receives notwithstanding his fraud.

Not quite the same deterrent effect as the billboard, eh?