Articles Posted in Workers Compensation

money-4-1238890-768x1024In workers compensation cases, the awarded money benefits can be offset in court to account for other benefits being received by the employee for the same injury like social security disability benefits. If the employer seeks to have the workers compensation benefits offset to account for social security disability they will need to file a “Motion for Recognition of Right to Social Security Offset” pursuant to La. R.S. 23:1225(A). The Louisiana First Circuit Court of Appeal was recently faced not only with a motion to offset due to social security disability but whether or not to include attorneys fees in the pre-offset amount or not. These particular issues arose out of a lawsuit brought by Stephanie Nitcher against Northshore Regional Medical Center (Northshore) for compensation for temporary or permanent total disability benefits, medical treatment and attorney fees.

On October 30, 2012, Ms. Nitcher was awarded workers compensation benefits including $86,871.84 in past due indemnity, $13,181.13 in interest and $550.47 in appeals costs all from Northshore. In addition, Northshore was ordered to pay Ms. Nitcher permanent total disability benefits in the amount of $329.96 per week from the date of the judgment forward. Ms. Nitcher in addition to the workers compensation benefits being paid by Northshore was receiving social security disability benefits pursuant to 42 U.S.C. § 423. On December 19, 2013, Northshore filed its motion for recognition of the offset of the social security disability benefits, which serves the purpose to allow an employer to offset the amount of money it’s paying out when the employee is essentially receiving payment for the same disabilities from both state and federal entities. The offset sought by Northshore would reduce their weekly payments to Ms. Nitcher by $115.52.  Prior to the hearing on Northshore’s motion, Ms. Nitcher filed to have her attorney’s fees taken out of her weekly workers compensation benefits, resulting in $65.81 coming out of the previously awarded $329.96. Northshore’s offset calculation did not deduct the $65.81 prior to calculating the $115.52 offset which resulted in their motion being denied and the judge ordering that Northshore’s offset amount be $49.71 a week lowering the original $329.96 to $279.35.

On appeal Northshore contends that the judge erred in denying the offset amount of $115.52, claiming that pursuant to La. R.S. 23:1225(A) the attorney’s fees did not need to be deducted prior to the offset calculation. The First Circuit Court of Appeal in determining the social security offset first looked to La. R.S. 23:1225(A) which states that the benefits provided for injuries resulting in permanent total disability will be reduced when the person is also receiving benefits under 42U.S.C. Chapter 7 (42 U.S.C. 423) which applies in this case since Ms. Nitcher is receiving benefits both from workers compensation as well as social security disability. From here the appeals court went on to determine how the offset should actually be calculated, the specific issue here being whether or not to calculate pre or post attorney fee deduction. The prior judgment approved the attorney fees deduction from the calculation referring to statutory attorneys fees which do allow for deduction prior to offset calculations, the fees at issue are however not statutory attorneys fees. The attorney’s fees, in this case, are limited by statute but not authorized by statute which would make them statutory attorney fees. The court went further to determine that since there is no Louisiana law that requires an employer to pay attorneys fees in connection with a workers compensation claim, that the only way to do so would be if it were a punitive order. That is however not the case here and since Ms. Nitcher does owe the attorneys fees it was properly deducted from her disability benefits, but Northshore was improperly made responsible for the fees by including the deduction in their offset assessment.

welder-1241607-1024x683The Louisiana Workers’ Compensation Act aims to protect employees who suffer on-the-job injuries. But in order to benefit from the act, plaintiffs have the burden of proving their claims. This means providing clear and convincing documentation of your injuries and work limitations. In a recent case, the Louisiana Second Circuit Court of Appeal found that the plaintiff failed in meeting this burden of proof.

Celia Sanchez was a card dealer at the Horseshoe Casino in Bossier City Louisiana which is owned by Caesar’s. She injured her back and hip in 2011 when she slipped and fell on a metal ramp at the Horseshoe Casino. In September 2013, Ms. Sanchez filed a disputed claim for compensation against her employer seeking indemnity benefits, medical treatment, penalties and attorney fees.

Caesar’s filed a request with the medical director of the Workers’ Compensation Administration that Ms. Sanchez undergo an independent medical examination (“IME”) with Dr. Robert Holladay. Ms. Sanchez opposed the request for IME and requested that the Workers’ Compensation Judge (“WCJ”) find that no IME was warranted. In the alternative, she requested that the WCJ appoint a physician trained who had fellowship training in spine surgery and actively treats spine patients. Dr. Holladay lacked both of these qualifications.

coloured-peppers-1319797-1024x768Appellate courts are reluctant to reverse a trial court’s judgment based on the argument the trial court failed to properly evaluate the evidence. Deference to a lower court is the norm. A recent decision by the Louisiana First Circuit Court of Appeal in DeBlanc v. Albertson’s highlights the principle of judicial deference.

The case’s origins lie in a workers’ compensation claim. Sidney DeBlanc III worked at Albertson’s as a produce clerk. On December 28, 2009, DeBlanc allegedly injured his back while he lifted a box of apples to place them on a cart. He then took a break, finished his shift, and went home but failed to mention the accident to a supervisor. None of his fellow employees witnessed the incident. His mother notified the store later. Two days after the accident, DeBlanc visited his personal physician, received a referral to a specialist, and he later filed a claim for workers’ compensation.

In March 2012, Albertson’s disputed the claim with the Office of Workers’ Compensation. The supermarket challenged whether DeBlanc injured his back on the job and if the specialist’s surgery recommendation was related to his employment with them. The case went to trial, and the Workers’ Compensation Judge (WCJ) found DeBlanc proved his injury and was entitled to disability benefits and the recommended surgery. Albertsons then appealed, based on the argument the WCJ’s judgment was not supported by the evidence.

frog-eye-1-1398595-1-1024x768“An eye for an eye will only make the world blind,” said Mahatma Gandhi. In a recent case, the Ritz-Carlton Hotel Company, LLC claimed that one of its employees filed a lawsuit against it as retaliation for her dismissal from the company. The Louisiana Fifth Circuit Court of Appeal was faced with the question of whether that employee actually suffered a compensable work-related injury or whether her claims were suspect.

Phyllis Summers was a hairdresser, nail technician, and makeup artist at the Ritz. On March 2, 2013, she arrived early to perform a pedicure for a guest. But her day took a turn for the worse as she slipped and fell from water leaking from one of the pedicure tubs. The Ritz suspended her employment on May 3, 2013, and later terminated her on May 16, 2013, for repeated violations of Hotel policy. Ms. Summers then filed a Workers Compensation Claim (“WCC”) on June 7, 2013, seeking compensation for a work-related injury. The Workers’ Compensation Judge (“WCJ”) granted her wage and medical benefits, along with penalties and attorney fees. The Ritz and Marriot Claims Service (“MCS”) appealed, arguing that Ms. Summers filed the lawsuit as an act of vengeance.

In reviewing a WCJ’s decision, the Court of Appeal may only overturn conclusions if a close examination of the facts in the entire court record shows that the WCJ was “clearly wrong.” See Dean v. Southmark Constr., 879 So.2d 112 (La. 2004).  In reviewing this case, the Fifth Circuit assessed whether (1) Ms. Summers’ accident was job-related; (2) her accident resulted in injury, or resulted in making an injury she already had worse; (3) she was entitled to temporary total disability (“TTD”); (4) she was entitled to supplemental earnings benefits (“SEBs”); (5) the injury warranted medical, medication and travel expenses; and (6) she had a right to penalties and attorney fees.

working-1229720-1024x783Workers’ compensation disputes often boil down to the terms of a written contract where each party asserts their own interpretation of the agreement and lets the court decide. The case below is no different as it pertains to a “third-party beneficiary,” which essentially is a party not expressly contained in the agreement, but is no less a party to the contract.

Mr. Scarberry was an employee of the Oklahoma Gas and Electric Company (OGE) and was helping Entergy Gulf States Louisiana, LLC (Entergy) restore power to residences and business in the midwest after hurricane Gustav caused damage to the area.

OGE and Entergy were members of a larger nonprofit trade association, Southeastern Electrical Exchange (SEE), and the relationship between members of SEE was governed by an Agreement, which is the backdrop of the dispute here between Mr. Scarberry, OGE, and Entergy.

green-hospital-1200005-768x1024In Louisiana, when an employee suffers an on-the-job injury, the employer may be held liable. This can easily end the initial romantic period of the employment, now that the employee’s interests are at odds with the employer’s. The employer considers that it now has to take care of a non-productive employee, hurting the business’s bottom line. On the other hand, the employee argues that she should be compensated for her work-related injuries considering all the labor she put into the company, contributing to its profits. The law takes into account and draws a delicate balance between these varying interests. It goes without saying that it is important for both employees and employers to be aware of their rights under workers’ compensation law. Illustrating this point, the Louisiana Third Circuit Court of Appeal was recently called upon to decide whether a potentially expensive surgical procedure made necessary by a work-related injury should or should not be granted.

Jacquenette Guidry, a registered nurse, injured her back on June 12, 2012, in the while on the job at American Legion Hospital. The injury occurred while she transferred a patient to the bed. She developed low back pain within fifteen to twenty minutes of the transfer and American Legion sent her to the emergency room. Novare, American Legion’s workers’ compensation carrier denied Ms. Guidry coverage for a posterior lumbar decompression and fusion at L4-S1 with post-operative bracing. She then sought approval for those procedures from the Louisiana Medical Director of the Office of Worker’s Compensation. The Medical Director also denied Ms. Guidry’s requested medical procedure in a Medical Guidelines Dispute Decision dated May 27, 2014 (the “MGD”).

Ms. Guidry appealed the MGD by filing a disputed claim for compensation (Form 1008) with the Workers’ Compensation Judge (“WCJ”). The WCJ held in open court that she found clear and convincing evidence that the MGD was flawed because the Medical Director erroneously failed to consider the guidelines under which Ms. Guidry’s request was made. Ms. Guidry’s employer filed a suspensive appeal of the decision. A suspensive appeal “suspends” or delays the execution of the WCJ’s judgment until an outcome is reached on appeal.

compensation-1444901-1024x798Accidents occur everywhere including the workplace. Are you entitled to any benefits if injured while on the job? One common benefit of employment is the availability of worker’s compensation when injured on the job. Worker’s compensation is a type of insurance that grants wage replacement and medical benefits to employees injured in the course of employment. This in exchange relinquishes the right to sue the employer for negligence. Does it matter if you have been recently promoted or demoted? Calculating wage replacement benefits can often not be as clear-cut as it may appear. The following case describes the standards in Louisiana for calculating a salaried employee’s average weekly wage (AWW) for workers’ compensation benefits.

Jerome Augusta was injured in November of 2013 in a work-related accident while employed by Audubon. When Augusta began working for Audubon in November 2012, Augusta’s salary was $43,769.00. But in July 2013, he was demoted and his salary was lowered to $33,000.00. Audubon granted workers’ compensation benefits based on Augusta’s $33,000.00 salary at the time of the accident.

In March of the next year, Augusta filed a disputed workers compensation claim (Form-1008). He claimed that Audubon incorrectly calculated his benefits. This case went to trial before the Office of Worker’s Compensation (“OWC”). During the year before the accident, Augusta’s yearly salary was $42,824.76, factoring in his demotion., Augusta argued that his AWW should have been $823.55. Audubon argued it correctly calculated his AWW.

planning-for-construction-1234527-731x1024Have you ever suffered personal injury from an accident while traveling to or from work? Generally, pursuant to the Louisiana Workers’ Compensation Act employers are not responsible for injuries sustained by employees while traveling to or from work because these injuries are not considered to have occurred within the course of employment. This is known as the “going-and-coming” rule, under which the employment relationship is considered suspended from the time the employee leaves his or her workplace. However, there are certain exceptions to this rule that allow a claimant to recover even though the injury was sustained while traveling to or from work. The following case illustrates one such exception: if the accident occurred on the employer’s premises, the employee may be covered under workers’ compensation laws.

Arline Theriot was employed by Full Service Systems Corporation as a porter at a casino in Lake Charles, Louisiana. On December 25, 2012, Arline was on her way to work. Shortly before her shift was about to begin she was searching for a parking space in one of the casino parking lots when she was struck by a vehicle driven by another casino employee. Arline sustained an injury to her neck as a result of the accident and subsequently filed a Disputed Claim for Compensation with the Office of Workers’ Compensation.

Arline alleged that her employer had not authorized a neck surgery that was recommended by Dr. Gregory Rubino and sought penalties and attorney fees for her employer’s rejection of the neck surgery. The Workers’ Compensation Judge (WCJ) decided in favor of Arline, finding that her injury occurred in the course of her employment at the time of the accident, that the neck surgery recommended by Dr. Gregory Rubino was reasonable and necessary, and that the need for the neck surgery was causally related to the workplace accident. On appeal, the sole legal issue was whether Arline’s accident arose out of and occurred in the course of her employment. Full Service Systems disputed the WCJ’s findings and argued that her claims were not recoverable because she was on her way to work.

injury-1432459-1024x683One of the biggest fears of any parent is the sudden and unexpected death of your spouse, leaving only you to raise and provide for your children. The thought alone can be crippling. When tragedy strikes, one of the only comforts a surviving spouse can find is believing that they will receive financial compensation to relieve the monetary burden left behind by the loss of a spouse who provided a steady source of income. At the center of every wrongful death claim is the issue of getting the surviving family member relief to overcome the hardship of carrying on without their spouse or parent who helped support them. For individuals killed on the job, the Louisiana Workers’ Compensation Act (the “Act”) provides an avenue for compensation for surviving family members. Under the Act, an employee injured in an accident during the course and scope of the employment is generally limited to the recovery of workers’ compensation benefits as his exclusive remedy against his employer and may not sue his employer in tort. See La. R.S. 23:1032.

Likewise, when an employee is killed during the course and scope of their employment, surviving family members expect compensation from their loved one’s employer. Unfortunately, many companies elect to deny responsibility or claim to be free from fault rather than help the family. Moreover, oftentimes workers’ compensation benefits do not adequately compensate for the loss of a loved one. While these workers’ compensation benefits may be subpar, they are at least guaranteed to the surviving family members.

Other companies that may be responsible for a workplace injury may attempt to label itself as an employer of the injured person in order to protect itself from a tort lawsuit by using the Workers’ Compensation Act as a shield. Whenever this happens, it is imperative that surviving family members have adequate counsel to identify the scheme these companies are attempting to carry out. A recent case out of New Orleans, Louisiana highlights the struggle that grieving family members face when attempting to receive compensation from the companies responsible for a workplace fatality.

roadman-1395447-695x1024No one wants to be injured at work and thus be unable to continue working to pay one’s bills.  Worker’s compensation exists to assist employees who may have been badly injured in the workplace. Among the benefits that may be paid after an employee has suffered a debilitating injury are temporary total disability benefits, (TTD), and supplemental earnings benefits (SEB). TTD benefits are awarded on an employee’s proof that he or she cannot work at all following injury, equal to two-thirds of the pre-injury wages. La.R.S. 23:1221(1)(c).  Supplemental earnings benefits are paid out when an employee is limited in his or her earning capability following an injury, payable at two-thirds of the difference between wages before the injury and those earned after returning to work. La.R.S. 23:1221(3)(a)(i).  Upon proof of an employee’s ability to work productively, an employer may be able to change the higher TTD payments to SEB payments.

In Louisiana, just because an employee has suffered from conditions that predate an incident of injury does not mean that that employee is to be prevented from recovery under worker’s compensation for that work-related injury.  If some accident in the workplace aggravates or reinjures a part of the body that has been previously injured, and this aggravation is to the point of disability, then an injured employee may bring a claim for disability.  The plaintiff still must prove that the workplace injury in question caused the disability.  However, it is enough to show that the injury could be factored into the chain of events that created the disability.  In this situation, the employee must show only that the disability did not exist before the accident, that the symptoms arose after the accident, and evidence that tends to show that it is possible that the disability could have resulted from the alleged incident.

As people age, their bodies become frailer and prone to injury.  Medical procedures necessary to restore one’s abilities to function in daily life as well as the workplace have beneficial effects but can also leave a person vulnerable to an increased risk of injuries.  These factors, alone or combined, can mean that an injury that does not sound very serious can prove debilitating to a person, as Cathy Turner discovered.  In December 2011. the 60-year-old Ms. Turner was a full-time admissions coordinator at the Lexington House nursing home in Alexandria, Louisiana.  On December 12th, she was accidentally struck on the hip by a swinging door.  This injury just so happened to be at the same location as her recent total hip replacement surgery in September of 2011.  This was the site of two previous hip surgeries as well.  After this incident, she experienced a tremendous amount of pain and inability to walk or even stand on the injured hip.  Multiple doctors concluded that Ms. Turner had become disabled due to the injury and the additional surgery required to help ease the constant pain. The extent of her injuries necessitated that she obtain a motorized scooter in order to get around when before she had been able to walk.  As such, the evidence tended to show that the disability stemmed from the work injury rather than the several pre-injury operations.  Most people who undergo these varieties of surgeries, according to the medical evidence, generally see improvement.  Regardless, Lexington House refused to pay the disability payments, claiming that her preexisting condition the three previous surgeries. The company also did not pay any supplemental earnings or for necessary medical tests.  Ms. Turner filed a worker’s compensation claim.  The Office of Worker’s Compensation (OWC) ordered her employer to pay her disability payments, an award for reconstructive surgery and medications, and penalties for failing to pay out certain specified benefits.

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