|Hodge v. State Fund [1/17/01] 2001 MTWCC 1 Where claimant is seeking additional workers' compensation benefits, evidence of fraud may be admissible irrespective of the insurer alleging an affirmative defense of fraud since such evidence may undermine claimant's credibility and his claim as to the nature and extent of his disability.|
|Taylor v. State Compensation Insurance Fund, 175 Mont. 432, 913 P.2d 1242 (1996) Fraud can never be presumed but must be proved by a preponderance of the evidence. To sustain a claim of fraud, insurer was required to plead and prove each of the nine elements of fraud: (1) a representation; (2) falsity of the representation; (3) materiality of the representation; (4) speaker’s knowledge of the falsity of the representation; (5) the speaker’s intent it should be relied upon; (6) the hearer’s ignorance of the falsity of the representation; (7) the hearer’s reliance on the representation; (8) the hearer’s right to rely on the representation; and (9) the hearer’s consequent and proximate injury caused by reliance on the representation.|
Taylor v. State Fund [8/21/95] 1995 MTWCC 61 and Taylor v. State Fund [10/6/95] 1995 MTWCC 77 Although the Workers’ Compensation Court was made aware that a criminal proceeding alleging fraud was pending against claimant, that fact and documents pertaining to that prosecution were not evidence of fraud.
|Taylor v. State Fund [8/21/95] 1995 MTWCC 61 and Taylor v. State Fund [10/6/95] 1995 MTWCC 77 With regard to two of three claims filed by truck driver, insurer sustained its burden of proving fraud, entitling the insurer to an order of reimbursement from claimant for medical and compensation benefits paid on the two claims. In finding the insurer proved the nine required elements of fraud, the Court relied on credible testimony of witnesses who said claimant told them he was “scamming the system,” but also on evidence that claimant had a financial motive, was unhappy with his job and angry at his supervisors, inconsistencies in claimant’s statements to medical providers and others, lack of objective medical evidence of some injuries, and evidence that claimant exaggerated and fabricated injuries and symptoms, some of which were anatomically inappropriate.|