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Appeals court cites fraud in denying workers’ comp benefits

Despite seeing four orthopedists and later citing “a lack of mental acuity,” Todd Romero’s worker compensation benefits were given “the boot” by the 3rd Circuit Court of Appeal.

A Louisiana appeals court has sided with a workers’ compensation judge (WCJ) and against a former offshore worker who was “injured” on the job in February of 2013. The 3rd Circuit Court of Appeal agreed with Lafayette Parish Workers' Compensation Judge Sharon Morrow that Todd Romero committed fraud when he failed to disclose a prior injury — including surgery and workers' comp benefits — to the same ankle he claimed to have injured in February 2013.

Romero was employed by The Wood Group PSN when, in February of 2013, he claimed to have injured his left ankle while stepping onto a well platform from a crew boat in Black Bayou. The appeals court opinion reveals that no one witnessed the incident in which Romero claims to have injured the ankle, but he was transported to a medical facility in Plaquemines Parish where he was diagnosed with a sprained ankle.

Evidently not satisfied with the diagnosis, Romero continued to see a series of orthopedists, none of whom, according to the court record, were informed that he had injured the same ankle seven years earlier — an injury that required surgery and for which he received seven months of workers' compensation benefits.

When his employer discovered the subterfuge it contested his latest claim for benefits. Judge Morrow agreed in her ruling:

Romero’s excuses do not make sense under the circumstances and do nothing to counter the documented fact that every time he was asked about prior injuries, surgeries, MRIs or workers’ compensation claims he either denied any such thing or left the answer blank. There is deliberateness to his consistently false responses and omissions that point overwhelmingly to an attempt to hide information...

Suspicious of his claims, The Wood Group had hired an investigator to conduct surveillance on Romero, who had been instructed to wear an orthopedic boot to stabilize his “injured” ankle. That surveillance revealed that he wasn’t exactly following his doctors’ orders:

At trial, the employer presented video surveillance of Romero standing and walking without use of the boot during the time period he was being treated by Drs. Gidman and Greene and under orders to remain in the boot at all times. One portion of the video surveillance showed Romero pushing his apparently stalled pick-up truck backwards while not wearing his boot. The WCJ, in her written reasons for judgment, specifically noted this video as inconsistent with Romero’s complaints during the time period in question.

Romero claimed that he didn’t reveal the prior injury to the ankle because he assumed he had fully healed. The worker’s comp judge and the appeals court didn’t buy that claim, finding that his failure to disclose the prior injury constituted fraud.

Not to be outdone, Romero claimed he couldn’t have committed fraud because “he suffers from a lack of mental acuity sufficient to commit the fraud.” Romero cited the fact that he didn’t graduate from high school until he was 22 years old to prove he wasn't intelligent enough to commit fraud. The court noted, however, that Romero failed “to acknowledge that he has since earned a T2 production license, a hydrolic crane operator card and became qualified as a first-aid responder.”

“For the reasons set forth above,” the 3rd Circuit opinion concludes, “we find no manifest error in the WCJ’s determination that Romero willfully misrepresented his medical history and present condition for the purpose of obtaining benefits.”

Read the entire opinion here.