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Snyder v. North Dakota Workers Compensation Bureau2/20/2001
benefits that has been accepted by the bureau and willfully fails to notify the bureau of:
(1) Work or other activities as required under subsection 3 of section 65-05-08;
(2) The receipt of income from work; or
(3) An increase in income from work.
. In addition to any other penalties provided by law, the person claiming benefits or payment for services in violation of this section shall reimburse the bureau for any benefits paid based upon the false claim or false statement and, if applicable, under section 65-05-29 and shall forfeit any additional benefits relative to that injury.
Snyder argues:
A difference of opinion [about the meaning of "work"] does not amount to fraud or false statements. Wilbur considered his activities at the Midtowner therapy after his heart attack, in the absence of any direction from the Bureau. He got approval from his doctor to do it since formal rehab did not work for him before. He did not consider the money he got to be "pay", since it was given to him by his grateful friend. . . . It was error for the ALJ, the Bureau, and the lower court to ignore this evidence of record that Wilbur's statements were not "willful" to trigger the termination.
[ ] Here, there was more than a difference of opinion about the meaning of "work." Based on the common understanding of work, Snyder was making a false statement when he reported no work activity, see Jacobson, 2000 ND 225, 15, while he was opening the Midtowner Restaurant at 5:00 a.m. daily, baking rolls, turning on the grill, making coffee, signing receipts for deliveries, cooking and serving meals to customers, collecting money at the cash register, picking up supplies, and performing maintenance work for cash payments of $80 per month and food worth $30-60 per month.
[ ] "Section 65-05-33, N.D.C.C., authorizes the Bureau to use administrative proceedings to recoup benefits paid to a claimant based upon a false claim or statements and to require a claimant to forfeit future benefits for that injury." Vernon v. North Dakota Workers Comp. Bureau, 1999 ND 153, 12, 598 N.W.2d 139. To trigger the statutory consequences of N.D.C.C. ยง 65-05-33, for a false claim or statement, the Bureau must prove a claimant willfully made a material false claim or statement in connection with a claim or application under Title 65, N.D.C.C. Jacobson, 2000 ND 225, 9, 10. To be willful, conduct must be engaged in intentionally, not inadvertently. Id. at 9. If an injured employee has willfully made a false statement in connection with a claim, " e additionally require the Bureau to prove the false statement is material." Hausauer v. North Dakota Workers Comp. Bureau, 1997 ND 243, 12, 572 N.W.2d 426. "If the Bureau seeks reimbursement for benefits paid, the level of materiality required is proof by the Bureau that the false claim or false statement caused the benefits to be paid in error." Jacobson, at 10. "A false claim or false statement is sufficiently material for forfeiture of future benefits if it is a statement which could have misled the Bureau or medical experts in a determination of the claim." Id.
[ ] We addressed the materiality of a failure to report income in Unser v. North Dakota Workers Comp. Bureau, 1999 ND 129, 18, 22, 598 N.W.2d 89:
A failure to report income is, by the very nature of the violation, material to the Bureau's ability to determine a claimant's entitlement to benefits and to calculate the amount of benefits. By failing to report income a claimant impedes the Bureau's process of determining eligibility.
When the claimant's wrongful concealment of income impedes the Bureau's p
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