Chief Editor: Tracie Childers, Associate, Orlando
Author: Ana McQueen, Associate, Orlando
Author: Karli Sarratt, Associate, Tennessee
Editor: Karysa Eraclides, Associate, Sarasota
Editor: Jacob Berry, Associate, Georgia
Title: Mileage reimbursement requests: Did you take a closer look?
By: Ana McQueen| Orlando, FL
As we all know, a Claimant can seek to recover mileage reimbursement for mileage incurred while travelling to authorized medical appointments and/or while travelling to the pharmacy to pick up a prescription. Mileage reimbursement requests seem simple enough: Have the Claimant fill out a mileage claim form with the alleged mileage incurred and issue the reimbursement.
What if, upon further inspection of the mileage request, you notice the Claimant is inflating the mileage? You may be able to deny the claim in its entirety due to fraud/misrepresentation. Pursuant to Fl. Stat. §440.09(4) and Fl. Stat §440.105, all benefits should be barred due to fraudulent/misleading statements.
The Court in Rodriguez v. Beall’s Inc., OJCC Case No. 23-014791BKC, dealt with a Claimant seeking to obtain mileage reimbursement benefits, as well as other benefits. Upon reviewing the mileage submission, the Adjuster discovered that the mileage requested by the Claimant did not match the mileage one would incur while travelling to authorized medical appointments. As a result, a misrepresentation defense was raised for the entire claim.
The Judge considered the elements needed to prove fraud: (1) whether the Claimant made a false, fraudulent, or misleading statement; and (2) whether at the time the statement was made, it was made with the intent to obtain or maintain benefits. The Judge found that due to the excess in mileage requested and the Claimant’s inconsistent testimony, the Claimant knowingly and intentionally misrepresented his mileage with the intent to be paid for those miles. The pending claims and petitions before the Court were all denied and dismissed with prejudice.
Some key takeaways:
Here, the misrepresentation was not material to the other pending petitions. Notably, misrepresentation does not need to be material to the benefit requested. As explained in the court order, “. . . [T]he relevant inquiry is whether a Claimant’s misrepresentation – a misrepresentation the Claimant thought would have a material impact on his case – was made with the intent to secure benefits.” See Cal-Main Foods, 225 So. 3d at 903 (citing Arreola, 17 So. 3d at 794; and McKale, 911 So. 2d at 1282) (“misrepresenting your physical abilities to doctors, adjusters or in testimony to obtain or enhance compensation results in the forfeiture of benefits or compensation.”) (Emphasis added.)
Note that the Claimant’s conflicting testimony and the significant excess of mileage requested were key factors in the Employer/Carrier’s support of their misrepresentation defense. The Judge also considered the Claimant’s education level. The request for mileage by the Claimant was a blatant inflation and the Judge was able to determine the Claimant’s intent.
When considering if denying a claim is the right strategy where excess mileage has been requested by the Claimant, examine the following: (1) are the excess miles requested so inflated that it would be unreasonable for one to incur that much mileage; and (2) would the Claimant be able to offer a credible explanation in front of the Judge? Regardless of the litigation aspect in defending against the denial, this strategy can also be a helpful tool to push claims towards final resolution and overall settlement. If you are unsure where the case stands, feel free to reach out to the EG team!
Title: How to Keep the Holiday Spirit High and the Liability Risk Low While Celebrating the Holidays with Employees in Tennessee
By: Karli Sarratt | Nashville, TN
‘Tis the season for holiday celebrations, but ‘tis also the season for injuries. Holiday work parties foster team spirit and boost morale, but they also pose a risk of injuries. Tennessee law recognizes this and has developed safeguards for both employees and employers when it comes to holiday party injuries.
In Tennessee, employers may be held liable for injuries sustained by employees during work-related activities, including holiday parties. If employee George slips while dancing at the company Christmas party, is he entitled to benefits for his injury under Workers’ Compensation? That depends on several factors.
The Tennessee legislature codified the circumstances under which recreational and social activities would fall within the course of employment in Tennessee Code Annotated section 50-6-110(a)(6)(A). Tennessee employers have an affirmative defense against injuries resulting from an employee’s voluntary participation in employer-sponsored parties unless:
(A) Participation was expressly or impliedly required by the employer;
(B) Participation produced a direct benefit to the employer beyond improvement in employee health and morale;
(C) Participation was during employee’s work hours and was part of the employee’s work-related duties; or
(D) The injury occurred due to an unsafe condition during voluntary participation using facilities designated by, furnished by or maintained by the employer on or off the employer’s premises and the employer had actual knowledge of the unsafe condition and failed to curtail the activity or program or cure the unsafe condition
The Tennessee Supreme Court has applied this statute in cases such as Pope v. Nebco of Cleveland, Inc., 585 S.W.3d 874 (Tenn. Workers Comp. Panel 2018). In Pope, the Tennessee Supreme Court found that a claimant’s participation in an employer-sponsored event did not result in a compensable work injury because (1) the employer did not require the claimant’s participation, (2) the claimant was not compensated for time spent at the event, (3) the claimant was not required to make sales or network during the event, and (4) the claimant did not participate in a representative capacity or wear clothing that identified himself as an employee.
The employer has the burden of proving the defense described above. So, in planning your holiday celebrations, here are some steps you can take to minimize your risk of liability for injuries at these events:
1. Clearly Define the Event as Voluntary
Ensuring that attendance at the holiday party is voluntary is crucial. Employers should communicate clearly that participation is not mandatory and that there will be no repercussions for those who choose not to attend. This distinction can help demonstrate that the event falls outside the scope of employment.
2. Consider Holding the Party Off-Site and Off-Hours
Hosting the holiday party at a location other than the workplace can help separate the event from the work environment. By moving the event off-site, employers can better support the argument that the party is a social gathering rather than a work-related activity. Additionally, hosting during non-work hours and not paying your employees for time spent at the party can help tremendously with establishing your defense.
3. Limit Alcohol Consumption
Michael Scott taught us in the Office that adding alcohol to a holiday party can easily boost morale; however, it can also significantly increase the risk of accidents and injuries. Employers should consider limiting or eliminating alcohol at holiday parties. If alcohol is served, consider hiring bartenders who can monitor and control consumption. And encourage safe travel home, by providing a rideshare code.
4. Implement Safety Measures
Walk through the venue prior to the event to ensure trip hazards or other hazards are eliminated. And keep an eye out for spilled drinks that could develop a slip hazard.
5. Review and Update Company Policies
The end of the year is a great time to review company policies regarding workplace conduct. Ensure that they address off-site events and alcohol consumption. Clearly communicating these policies to employees before the event can help set expectations and promote responsible behavior.