Articles Posted in Negligence

If you are injured on the job, you might be entitled to compensation through the workers’ compensation system. What happens if your employer denies your claims for treatment recommended by your treating physicians? Can your employer be required to pay you penalties and fees?

Betty Citizen hurt her back while she was trying to move a bike while working at Wal-Mart. Wal-Mart denied her physical therapy that her treating neurosurgeon recommended. She filed a 1009 Form, which the Medical Director denied for being untimely. Citizen then filed a 1008 Form, claiming she was entitled to receive attorney fees and penalties because Wal-Mart had arbitrarily and capriciously handled her claims. 

Once Wal-Mart formally denied her physical therapy, Citizen filed another 1009 Form. The Medical Director denied that request as well, finding there was no required documentation about the results of prior therapy. On the day of the hearing, Wal-Mart approved the recommended physical therapy. Therefore, the only issue was whether Wal-Mart had acted arbitrarily and capriciously in denying Citizen’s physical therapy. 

When receiving medical care, the choice of medical professional can influence your treatment. If you have been injured on the job, you might not be sure if you can pick your own doctor or if you have to use a doctor your employer selects. Under the Louisiana Workers’ Compensation Act, an injured worker is entitled to select a physician in any specialty for an initial visit. The employer is not required to approve the employee’s choice of physician. What happens if the employer claims the employee was not injured on the job? 

Blann Kyle filed a workers’ compensation claim against Boise Cascade Company (“Boise”), claiming he had lost his hearing as a result of his employment at a paper mill located in DeRidder, Louisiana. He filed the claim seven years after he retired. Kyle then filed a motion for an expedited hearing, under La. R.S. 23:1121. Kyle claimed Boise had not authorized his initial visit with his choice of physician. Kyle wanted the workers’ compensation judge to order Boise to authorize his initial visit to the physician he had selected, reimburse him for the medical expenses resulting from the testing and treatment by that physician, and pay penalties and attorneys’ fees. Boise countered that Kyle’s claims were prescribed, meaning he had waited too long to bring his workers’ compensation claim. Boise also claimed it was not proper for Kyle to request penalties and attorneys’ fees with his motion for an expedited hearing. The workers’ compensation judge denied Kyle’s motion, holding there was a “tenuous link” between Kyle’s alleged hearing loss and his employment. Therefore, Boise had acted properly in refusing him the choice of a physician. Kyle filed an appeal. 

Louisiana courts have recognized that hearing loss can be caused by occupational exposure and can be an occupational disease where an injured worker is entitled to workers’ compensation. See Arrant v. Graphic Packaging International, Inc. Under La. R.S. 23:1121, an injured worker is entitled to select a physician in any specialty without his employer’s approval. If the employer denies that, the employee has the right to request an expedited proceeding. The employee can also receive attorney’s fees and penalties.