Articles Posted in Workers Compensation

boise-downtown-1387405-1-1024x681In workers’ compensation cases, often times the court is presented with the conflicting testimony and evidence of several physicians. For example, an injured employee may see several doctors over the course of his or her treatment. He or she may see an initial treating physician, a specialist, and may latter be referred to a doctor of the employer’s choice. The testimony of these physicians will be presented in court, and relied upon by the parties in arguing their claims or defenses. The court may even appoint its own doctor to aid it in its assessment of the plaintiff’s injury. In weighing multiple opinions from treating physicians, the Workers’ Compensation Judge (“WCJ”) has wide discretion to credit one physician over another. Absent manifest error or clear wrongness indicated in the trial record, a court of appeal cannot reverse the WCJ’s findings, as discussed in a recent case from the Louisiana Third Circuit Court of Appeal.

In 2010, Jason Montou was injured on the job while working for Boise Cascade Company. Immediately after the accident, Mr. Montou reported the incident to his supervisor and completed a Supervisor’s Incident Report. This report only referred to a shoulder injury. Mr. Montou was then admitted to the Oakdale Community Hospital in Oakdale, Louisiana. The hospital’s records indicated that Mr. Montou’s primary complaint was his right shoulder, and that he also complained of numbness in his right hand fingers. The hospital sent him home and told him to see an orthopedic doctor should his pain continue.

Days later, Mr. Montou contacted the workers’ compensation adjuster and requested that he see an orthopedic doctor. The adjuster granted his request and sent him to see Dr. Stephen Hale at the Center for Orthopedics. Dr. Hale performed surgery on Mr. Montou’s rotator cuff and referred him to Dr. William Lowry, a back specialist. Dr. Lowry refused to certify Jason to return to work until he obtained an MRI of Mr. Montou’s spine in his neck and back, because without the MRIs he couldn’t complete Jason’s treatment. Mr. Montou discontinued his treatment with Dr. Lowry, claiming that Boise refused to approve the MRIs.

sand-footprint-1539133-768x1024Not all Workers Compensation insurance claim decisions are black and white.  Sometimes those claims can include an overlap with other federal statutes that may or may not also provide coverage.  When those circumstances arise insurers need to base their decisions on the facts and the law and not for financial gain.  If done properly the denial of a valid claim does not automatically subject an insurer to penalties in Louisiana as the following case demonstrates.  

Global is a temporary employment agency that provides short-term workers for various construction and industrial purposes. On August 21, 2010 Global employee Librado De La Cruz sustained an injury while cleaning a beach impacted by the Deepwater Horizon oil spill. Global’s workers’ compensation insurer, Commerce and Industry Insurance Company (“Chartis”), denied the claim, refusing to provide benefits, because the insurer believed the employee’s eligibility for benefits under the federal Longshore and Harbor Workers’ Compensation Act (LHWCA) relieved its obligation.  Global believed this decision was not only wrong but that it was also made in made bad faith so they filed a lawsuit to challenge Chartis.

De La Cruz’s activities on August 21 brought into question whether or not the Chartis workers’ compensation policy covered his injury. He spent two hours that day loading and unloading a vessel at the pier. He then spent the next six or seven hours cleaning the beaches. While cleaning the beaches, he allegedly sustained the injury lifting a bag of oil-laden sand that would later be loaded onto a truck and transferred to a vessel for removal. The location of his injury was a few feet from Gulf waters and around a half-mile from the pier at which the vessel was docked. His duties and location were not in dispute.

xray-of-hands-1526780-1024x920Sometimes you get hurt while working and it’s neither your fault nor your employer’s fault.  In those cases the person that hurt you is called a “Third-Party Tortfeasor.”  However, because you were hurt while working you may have rights to not only sue the person who hurt you but to also receive workers compensation benefits.  Beware though, there are strict statutory rules that apply that dictate when you must file for medical and other benefits owed to you under the Louisiana Workers Compensation laws.  The following case out of Calcasieu Parish shows why you need to consult the best workers compensation lawyer immediately upon an injury that occurs while on the job.

On January 18, 2012, Lois Shailow, an employee of Gulf Coast Social Services (GCSS), was rear-ended by a third party while driving in the course and scope of her employment. She went to Lake Charles Memorial Hospital where she complained of back pain and was diagnosed with a lumbar strain. The hospital discharged Ms. Shailow on the same day with instructions to take her prescribed medication, to use a heating pad, and to follow up with her primary care doctor. She returned to work the second day after the accident.

On January 25, 2012, Ms. Shailow began seeing Dr. David Duhon, a chiropractor, for back pain. Dr. Duhon prescribed a lumbar spine MRI. During the ten months that he treated Ms. Shailow, she developed a foot drop which indicated a severe back injury. Dr. Duhon referred Ms. Shailow to Dr. Gunderson, who is an orthopedic surgeon. Mr. Gunderson found that Ms. Shailow’s MRI revealed two levels of disc herniation and recommended surgery.

quito-capital-of-ecuador-1227335-680x1024Not just any court can hear any case. Depending on certain factors, your local court may not be the right choice to bring your matter. A New Orleans attorney found this out the hard way in a recently decided case.

The matter arises out of a situation where the court affirmed a workers’ compensation judge’s ruling granting Mr. Feingerts’ attorneys $10,000 upon Mr. Feingerts’ $50,000 settlement. Mr. Bruce Feingerts was at one time represented by James Babst for the case that resulted in a settlement. After two requests for payment from Mr. Feingerts’ attorneys who actually settled his case, Mr. Babst petitioned for concursus regarding the the disputes and submitted the settlement funds to the concursus proceedings in the Orleans Parish Civil Court.  However, this was not the court in which the case was currently being litigated.  At the time Babst filed the concursus the case was still pending with the Office of Workers’ Compensation Administration.

The Louisiana Code of Civil Procedure defines a concursus as a proceeding where multiple parties having competing or conflicting claims to money can combine their cases and present their claim against the other claiming parties (La. C.C.P. art. 4651). Not being happy with having to litigate a separate case in a new court, Mr. Feingerts lawyers sought to implement the judgment and sought a penalty against Mr. Babst for their time and effort with the Office of Workers’ Compensation Administration (“OWCA”) stating that they were the only court that should hear the concursus proceedings. The OWCA agreed and heard the case.

construction-series-ii-1-2-1577115-1024x683Worker compensation claims arise from being hurt at work.  Even the best worker compensation lawyers cannot help you prove the existence of a work related accident if you were not actually “hurt at work.”  La. R.S. 23:1031(A)  The following case out of New Orleans demonstrates what happens when credibility assessments must be made due to a lack of physical evidence.

In January of 2013, Mark Tubre filed a Disputed Claim for Compensation that arose from the denial of a workers’ compensation claim for a back injury he allegedly sustained while working for the Automobile Club of Southern California, (“AAA”). Mr. Tubre was the manager of the AAA fleet facility located in New Orleans.  As a result of filing the Disputed claim for Compensation a trial occurred.  At that trial Mr. Tubre testified that on Christmas Day in 2012, while he was the only one at work, he slipped on a palette as he was placing a battery back onto a shelf. The accident aggravated a preexisting back injury that Mr. Tubre had and was seeing a doctor for.

In further support of his claims, Mr. Tubre presented three witnesses to speak on his behalf: (1) his neighbor, Daniel Edwin Oser, who testified he went to Mr. Tubre’s home on Christmas day and saw him resting on the sofa; (2) his bother, Henry Larry Tubre, Jr., who testified he spoke with Mr. Tubre on Christmas day and had been told that Mr. Tubre hurt himself doing something with a battery; and (3) his wife, Kim Tubre, who testified Mr. Tubre came home from work on Christmas day stating he had been hurt doing something with a battery.

helicopter-1450413-1-683x1024Many people have nightmares of falling and nobody being there to catch them. For Tommie Hebert, that nightmare became a reality when he fell from a moving helicopter, landing directly on his back, causing severe injuries such as a broken back and a damaged hip that would likely require replacement. To make matters worse, the company he worked for, Industrial, was not there to catch him.

J. Oran Richard, owner of Industrial, owned another company, Game Management Inc., ( GMI) that leased large tracts of land for hunting, fishing and farming in Louisiana and Texas. GMI did wildlife surveys in Mexico by helicopter, where deer were tracked and netted. It was common for employees to work for both companies.  Tommie Hebert was primarily a truck driver for Industrial, and would only go on the helicopter trips because Michael Richard, the owner’s son, was someone he considered his friend.  Typically Hebert would only go when another person could not make the trip.  Unfortunately for Herbert on one of these trips he fell from the helicopter and a lawsuit against his employers followed.

One would assume that netting deer in Mexico would not be considered in the scope of employment for someone whose job is to drive a freight truck. But that is exactly what Industrial was claiming in the lawsuit that Hebert brought against them. In the original lawsuit, a jury found in favor of Industrial that Herbert was working for them when injured, mainly because they had determined through testimony that Hebert had been on the job and had done this type of work many times before.  Therefore Herbert could not recover damages from Industrial or its owner, J. Oran Richard, or his son, Michael Richard in tort.  Herbert would only be allowed to recover workers compensation benefits. GMI was found to have no legal duty to Hebert, Industrial was found to be forty-four percent at fault, and Hebert, the man who was determined to be permanently disabled, was found to be fifty-six percent at fault for his injuries.

the-old-sawmill-hdr-1209113-1-1024x759If  you are injured while at work, there are many paths that you may take for financial relief. The path that you choose along with how you navigate that path will be a decision that will affect you for the rest of your life. The following case out of  Tangipahoa parish demonstrates why it is necessary in workers compensation cases to comply with certain orders and if you don’t why objections to rulings based on your lack of responses will not be considered.

On May 2, 2008, Mr. Carlton Williams was injured during the course of his employment at a sawmill as a delivery driver when a forklift driver dropped several pallets on top of him, knocking him unconscious. Mr. Williams alleged injuries to the head, shoulder, neck, left foot, right knee, lumbar, and various other injuries. Mr. Williams filed a tort claim against the forklift operator’s employer and the employer’s insurer, which settled out of court.

After being injured at the sawmill Mr. Williams received workers compensation benefits because the injury occurred at his job. If a third party is responsible for someones injuries that occur at work, which occurred in this case, the injured worker can file a lawsuit against that third party and at the same time receive workers compensation benefits.  However, when you resolve the lawsuit against the third party you will be forced to pay back the workers compensation carrier all the benefits they paid you.

workers-1215831-1-1024x683It  seems an insurance company’s first response to a claim is to deny the claim. The Louisiana Workers’ Compensation Corporation (“LWCC”) is no exception. The following case out of Loreauville Louisiana demonstrates the  arguments that can be made and standards to assess whether an injured employee is due LWCC’s benefits or benefits as a longshoreman.

Luis Hernandez was working on the Bayou Teche in Loreauville when he suffered an injury while cutting timber. Mr. Hernandez was hired to build a boat ramp into the Bayou Teche. He was injured  while working in a grassy area between thirty and one hundred feet away from the boat ramp. Mr. Hernandez filed a claim for compensation with the Office of Workers’ Compensation in 2014 after  receiving his injuries. He was employed by UNO Enterprises, LLC and Louisiana Workers’ Compensation Corporation was UNO’s workers’ compensation carrier. LWCC denied  coverage of the claim asserting that Mr. Hernandez was a longshoreman under the Federal Longshoreman & Harbor Workers’ Compensation Act (“LHWCA”) found in the United States Code in Title 33. Therefore,  the LWCC reasoned that their policy did not provide for coverage for Mr. Hernandez but rather the LHWCA applied.

Good lawyers know to challenge an insurance company’s claim denial, which is what Mr. Hernandez’s  attorney did in this case. After a lower court decision an appeal was filed and the Louisiana Third Court of Appeals received the case to utltimately decide whether the LHWCA did apply and thus whether LWCC would be required to provide workers’ compensation coverage to Mr. Hernandez.

oak-logs-1511548-1-1024x768In Louisiana as in other U.S. states, the doctrine of res judicata – literally “a matter judged” – prevents parties from re-litigating a matter once it has been adjudicated on the merits by a competent tribunal. This prevents prolonged litigation of cases which have been purportedly concluded, thus avoiding an unnecessary waste of time and money. Although for res judicata to apply a judgment must be “final” and adjudged “on the merits,” a settlement agreement in Louisiana is res judicata between the parties and is accorded the same effect as a final judgment. (See Louisiana Workers’ Comp. Corp. v. Betz, 792 So.2d 763, 766 (La. Ct. App. 2001)). In other words, the signing of a settlement agreement can preclude parties from litigating matters specified as settled in the settlement. It goes without saying that parties should be cautious when signing settlement agreements. Illustrative is a case from the Louisiana First Circuit Court of Appeal.

On October 10, 2005, Joseph Brown was injured in a logging accident while in the course and scope of his employment with AM Logging in Tanigipahoa Parish.  Mr. Brown filed a disputed claim for compensation on October 19, 2005 against the appellees in this case, AM logging and its claims administrator, Alternative Service Concepts, L.L.C. On July 14, 2006, AM Logging submitted a report to the Office of Workers’ Compensation (“OWC”), listing injuries to Mr. Brown’s collar bone, left ribs, and back. On July 24, 2009 – almost four years after his original disputed claim – Mr. Brown filed a second disputed claim listing injuries to his shoulder, ribs, back, chest, and neck.

After a hearing on Mr. Brown’s first disputed claim for compensation, the OWC held that Brown sustained a compensable work-related injury in the course and scope of his employment with AM Logging. It also found that Mr. Brown was permanently disabled with no reasonable possibility of rehabilitation through training or education, such that he could attain suitable and gainful employment. In its judgment of March 29, 2010, the OWC ordered AM Logging to pay Brown permanent total disability benefits of $121.00 per week, retroactive to December, 7, 2008 and continuing. It also ordered AM Logging to pay Brown $5,000.00 in penalties and attorney fees.

labourer-1436010-1024x762Louisiana worker’s compensation laws allow for injuries to only be charged at the usual cost for treatment. When a worker suffers an injury on the job the amount a hospital receives to pay for treatment may not always cover the cost of the treatment, but the hospital may not be able to recover for these losses.

While working at Beverly Industries, L.L.C. Byron Mitchell Suffered an injury to his back. The treatment for Mitchell’s back required the surgical fusion of three of the disks in his back. The surgery took place at Crescent City Surgical Centre in Metairie, Louisiana. Beverly Industries had worker’s compensation insurance through The Gray Insurance Company.

While Gray made all per diem payments to Crescent City for the surgery, the insurer denied coverage for special reimbursement for the surgery. Mr. Mitchell’s Surgical Procedure cost almost $180,000, and Crescent City sought reimbursement for the full cost of the procedure. The Surgical Center filed a claim for compensation, and a trial was held on December 19th 2012.

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