AI Generated Opinion Summaries

This summary was computer-generated without any editorial revision. It is not official, has not been checked for accuracy, and is NOT citable.

Facts

A worker sustained a work-related injury in 1994 and began receiving temporary total disability (TTD) benefits. The worker was later observed assisting in her boyfriend's restaurant business without pay, performing tasks such as taking orders, handling money, and serving food. The employer alleged that the worker failed to report her return to work, as required by workers' compensation rules, and sought termination of her TTD benefits (paras 2-10).

Procedural History

• Workers' Compensation Judge: Terminated the worker's TTD benefits, finding that the worker fraudulently failed to report her return to work (paras 1, 11).

Parties' Submissions

• Worker-Appellant: Argued that there was insufficient evidence to prove fraud or that she had returned to work. Claimed that her activities at the restaurant were unpaid assistance and did not constitute "work." Further argued that the employer failed to offer her work as required by law and sought attorney fees for the appeal (paras 12, 19-20).
• Employer/Insurer-Appellees: Asserted that the worker's activities at the restaurant constituted a return to work, which she failed to report, amounting to fraud. Presented surveillance evidence and testimony to support their claim (paras 3-10, 12).

Legal Issues

• Was there sufficient evidence to support a finding of fraud by the worker for failing to report a return to work?
• Did the worker's activities at the restaurant constitute "work" under the workers' compensation rules?
• Should the worker's TTD benefits have been terminated based on her alleged failure to report a return to work?

Disposition

• The Court of Appeals reversed the termination of the worker's TTD benefits and remanded the case for reinstatement of benefits and an award of attorney fees (paras 24-25).

Reasons

Per Bustamante J. (Pickard CJ and Hartz J. concurring):

• The Court found insufficient evidence to support the Workers' Compensation Judge's finding of fraud. Fraud requires clear and convincing evidence of an intentional misrepresentation of a material fact, which was not present in this case (paras 16-19).
• The worker's unpaid assistance in her boyfriend's business did not clearly constitute "work" under the workers' compensation rules. There was no evidence that the worker knew she was required to report such activities, nor was there evidence that she was paid for her assistance (paras 19-20).
• The Court emphasized that disbelief of testimony alone cannot serve as a basis for finding fraud. Affirmative evidence of fraud is required, and none was provided (para 21).
• The Court declined to address the consequences of an unintentional failure to comply with reporting requirements, as the case was decided on the lack of evidence for fraud (para 21).
• The Court ordered the reinstatement of the worker's TTD benefits and an award of reasonable attorney fees, as the employer failed to meet its burden of proof (paras 24-25).