A Louisiana appeals court has revived LUBA Workers Comp’s fraud dispute against a former claimant, spotlighting the challenges insurers face in contesting workers’ comp claims.
On October 1, 2025, the Louisiana Court of Appeal, Second Circuit, reversed a trial court’s dismissal of a case brought by LUBA Workers Comp and TruCare Home Health, LLC against former employee Rebecca Sears. The case revolves around allegations that Sears made false statements to her medical providers in order to obtain additional workers’ compensation benefits following a workplace injury in 2014.
According to court documents, Sears was injured in a car accident in Monroe, Louisiana, while working for TruCare Home Health. She received workers’ compensation benefits for injuries to her neck and back. Nearly a decade later, in November 2023, LUBA and TruCare filed a disputed claim, alleging that Sears had provided misleading information to her doctors about the extent of her injuries and her physical limitations. The insurer argued that these statements, made between late 2021 and mid-2023, resulted in recommendations for further medical treatment and additional benefits that may not have been warranted.
LUBA’s claim specifically accused Sears of violating Louisiana Revised Statute 23:1208, which addresses fraud in workers’ compensation claims. They asserted that Sears’ statements to her medical providers were inconsistent with her actual abilities and daily activities. LUBA sought to have her future benefits forfeited and to recover benefits already paid.
Sears responded by denying any fraudulent conduct and challenged the sufficiency of LUBA’s allegations. She argued that the claim did not specify which statements were allegedly false or when they were made. The Workers’ Compensation Judge agreed with Sears, finding that LUBA’s pleadings were too general and lacked the particularity required by Louisiana law. The judge dismissed the case but gave LUBA the opportunity to file an amended claim with more detailed allegations.
Instead of immediately amending their claim, LUBA sought supervisory review from the appellate court, which was denied. LUBA then filed an amended claim, this time including a detailed table of statements allegedly made by Sears to various medical providers. However, Sears moved to strike the amended claim, arguing that it was filed after the 15-day deadline set by the judge. The Workers’ Compensation Judge agreed and dismissed the case with prejudice.
On appeal, the Second Circuit reversed the dismissal. The appellate court found that, although LUBA’s amendment was filed after the deadline, Sears had not moved for dismissal before the amendment was filed. The court clarified that when a judge allows a claim to be amended, the case is not automatically over if the amendment is late – unless the other side asks for a dismissal first. The court also noted that motions to strike are a drastic remedy, intended only for allegations that are clearly irrelevant and prejudicial.
With the October 1, 2025, decision, the case is headed back to the lower court for further proceedings. For insurance professionals, the ruling serves as a reminder of the importance of specificity and timing when contesting workers’ compensation claims. It also highlights the procedural complexities that can influence the outcome of a dispute, even when fraud is alleged. The case underscores the need for insurers to be meticulous in documenting and presenting fraud allegations, as well as the importance of adhering to procedural deadlines throughout the litigation process.
