Articles Posted in Workers Compensation

bedroom-bliss-no-3-1542621-1024x768Workers’ compensation claims can be very stressful for the injured employee. Because of this, the law in Louisiana will help offset the legal costs of workers’ compensation claim denials by employers by awarding penalties and attorney fees ( PA&F) if the employer is found to have improperly denied the employees claims for medical treatment. This was the case for a Calcasieu Parish employee who experienced trouble sleeping due to pain from her injury. So, what do you do when your employer denies your workers compensation benefits?

Stephanie Lemelle Ardoin was injured while working for the Calcasieu Parish School Board at the beginning of 2013. After the injury, she was awarded workers’ compensation benefits and received treatment for her back injury. Ms. Ardoin’s treatment included a laminectomy. She also had a fusion of her L4-5 vertebrae performed by Dr. Chris Gunderson.

Following the surgery, Ms. Ardoin received care from Dr. Gunderson and was also provided with care from Dr. Daniel Hodges to deal with pain. She received care from Dr. Hodges because she was still experiencing pain and was having problems sleeping. Eventually, both doctors gave a prescription for an adjustable mattress to help with the sleeping issues. The adjustable mattress request was sent to WellComp Managed Care Services for review. WellComp denied this request on the grounds that it did not meet the Workers Compensation insurance guidelines. WellComp stated the claim was inadequate because there was no medical rationale to support the need for the adjustable mattress.

https://www.louisianapersonalinjurylawyerblog.com/wp-content/uploads/sites/310/2019/05/3_26_19-60.-Butler-v.-Jefferson-Parish--1024x683.jpgNo one can ever truly be prepared for the death of a loved one. It can present many unforeseen challenges, especially when complicated by the process of obtaining survivors’ benefits.

After the death of her husband, Jane Butler filed a “disputed claim for compensation” seeking death benefits, as allowed under La. R.S. 23:1231, with the Office of Workers’ Compensation (OWC). La. R.S. 23:1231 provides benefits for any legal dependents of an employee whose death occurs within two years resulting from an injury. Mrs. Butler filed the disputed claim on January 7th, 2013. Her husband Robert Butler, a retired Jefferson Parish firefighter, passed away from a heart attack on May 5th, 2013.

Mrs. Butler contended her husband experienced chest pains and underwent surgery placing a stent in his right coronary artery in July 2004. On September 23rd, 2004, Mr. Butler filed a claim under La. R.S. 33:2581, commonly known as the Heart and Lung Act, for compensation and disability benefits. Mr. Butler continued to receive these benefits up to his death in May 2013. However, Mr. Butler’s original death certificate listed his death as attributable to “unspecified natural causes.” The coroner corrected Mr. Butler’s death certificate to appropriately reflect the cause of death, myocardial infarction, in October 2014.

Constr-hats-768x1024Dot your i’s and cross your t’s. We’ve heard it since kindergarten. Yet, sometimes it is easy to forget the basics when a case seems to be open-and-shut.

In 2003, Mr. JL, an East Baton Rouge employee of Landis Construction Company (“Landis”), was injured on the job. Landis’ insurance carrier, (“Gray”), paid workers’ compensation and medical benefits to the employee. Landis and Gray asked the Office of Workers’ Compensation Administration (“Board”) to reimburse the payments made to Mr. JL but the Board denied the request. Six years later, Landis and Gray entered a Consent Judgment with the Board. Later, in 2013, Landis and Gray filed a Petition to Enforce Consent Judgment to enforce the 2009 Consent Judgment. One year later, in 2014, Landis and Gray filed a Motion to Enforce Consent Judgment.

The trial court held for Landis and Gray, awarding $28,095.60 in April of 2017. The Board appealed.

revolt-368925-unsplash-1024x683Imagine you are driving home from work and you collide with another vehicle. Would your employer be liable for the damages? For most commuters, the employer is not accountable for any accidents that occur on the way to or from the place of work and the employee’s residence. But in certain cases, such as where an employee is traveling with a specific business purpose under the direction of the employer, the employer may be on the hook under a theory known as vicarious liability. Effectively, vicarious liability holds an employer liable for an employee’s negligence when the employee is acting within the scope of the employer’s business. La. C.C. art. 2320.

On December 20, 2009, James Richards was traveling from Texas to his home in Florida along Interstate 10. In Bienville Parish, Louisiana, Richards collided with a van, causing the death of the driver and severe, paralyzing injuries to the passenger, Ricky Winzer. In 2010, Winzer filed a lawsuit against Richards and Richards’s employer, Certified Constructors’ Service, Inc. (“CCSI”). Winzer alleged that Richards was acting in the course and scope of his employment at the time of the accident, making CCSI liable through the doctrine of vicarious liability. CCSI filed a motion for summary judgment, arguing that Richards was not employed at the time of the accident and therefore CCSI could not be liable for his negligence. The trial court, after an evidentiary hearing in which depositions, interrogatories, and payroll documents were submitted, granted CCSI’s motion. Winzer appealed to Louisiana’s Second Circuit Court of Appeal.

Upon review, the Court reiterated the general rule under Louisiana jurisprudence that an employer is not liable for an employee’s negligence when they are driving to and from work unless the employer provides the transportation, pays expenses or wages for the time spent traveling, or has assigned the employee a specific  task to perform for the employer. See Woolard v. Atkinson, 988 So. 2d 836 (La. Ct. App. 2008). To determine if the employee’s actions fall within one of the above exceptions, courts must examine the following factors:  the employer’s power of control; the employee’s duty to perform the act in question; the time, place, and purpose of the act in relation to the employment; the relationship between the employee’s act and the employer’s business; the benefits received by the employer from the act; the employee’s motivation for performing the act; and the employer’s reasonable expectation that the employee would perform the act. See Orgeron v. McDonald, 639 So. 2d 224 (La. 1994).

elevator-1234161-1024x768When accidents happen, especially at work, it is natural for us to want to be made whole again: put back together as much as possible so our lives can return to normal. Sometimes, recovery for these accidents only covers the harm we can see. A worker injured on the job may appear healed physically but have more internal healing that needs treatment. This issue was examined in a workers’ compensation case appealed to the Louisiana First Circuit Court of Appeal in 2016.

Gary Thompson worked as a program monitor for the Department of Health and Hospitals, Office of Public Health. On February 15, 2011, Thompson left work at the end of the day and took the elevator as his office was on the eighth floor. When the elevator descended past the third floor, it suddenly fell and hit the ground level with a strong impact. Thompson’s post-incident MRIs showed serious injuries to his knees, hip, and upper and lower lumbar spine. Thompson had to undergo bilateral knee arthroscopy and other procedures, but no procedures performed relieved him of his back pain and other symptoms. Thompson’s orthopedic surgeon, Dr. Jorge Isaza, recommended a discogram to determine whether Thompson was a surgical candidate and Dr. Allen Johnston, appointed by the Office of Workers’ Compensation (OWC), reported that he agreed with the recommendation.

The OWC medical director approved the discogram and it revealed pain generators in Thompson’s back at Ll-2, L2-3, and L5-S1 levels. Dr. Isaza performed surgery on the L5-S1 level in April of 2013, but this did nothing to relieve Thompson of pain. Dr. Isaza recommended post-surgery diagnostic tests. At this point, OWC refused approval to conduct those tests. Dr. Isaza recommended another lumbar fusion on the L2-3 and Ll-2 levels, to treat the upper lumbar injury, which a May 14, 2012, MRI report confirmed the need for. The OWC also denied coverage of this procedure.

time-s-slipping-away-2-1419474-683x1024When an employee is injured on the job, workers’ compensation is often a faster and more efficient method to seek damages than other judicial remedies. Once a judgment is entered, it is important for the injured party to promptly collect damages because this judgment could prescribe, or no longer be enforceable.

Deborah Beebe was injured while working at Paul Eikert’s store in 2002. Two years later on November 16, 2004, a Worker’s Compensation Judge (“WCJ”) awarded Ms. Beebe damages of $7,666.25 in medical bills, $6,000 in penalties an attorney fees, and any future medical bills relating to the accident, all of which Mr. Eikert had to pay. Ms. Beebe waited until 2014 to seek payment from Mr. Eikert for these damages, of which Mr. Eikert was unaware. He filed to nullify the WCJ’s judgment on August 20, 2014, due to lack of notice. On September 4, Ms. Beebe filed an exception to his petition, one month later Mr. Eikert filed an opposition to her exception, Ms. Beebe then filed another exception, and on December 17, 2014, Mr. Eikert filed a motion arguing that the 2004 judgment had prescribed because ten years had passed.

Ms. Beebe filed a petition to revive her Worker’s Compensation judgment on January 7, 2015. In the alternative, she argued that her judgment was not a money judgment and thus needed no revival. The pertinent rule here is La. C.C. art. 3501 which states that “a money judgment rendered by a trial court of this state is prescribed by the lapse of ten years from its signing . . . .” La. C.C. art. 3501. Accordingly, Ms. Beebe argued that the judgment was not a money judgment (and thus the statute did not apply), while Mr. Eikert argued that it was a money judgment and thus had prescribed.

construction-worker-safety-gear-1024x683Almost every adult American has thought about what would happen if they were injured at work. They ask would they receive enough to sustain their pre-injury lifestyle and if not, what remedies are available. Typically, employees are eligible for workers’ compensation, but the workers’ compensation system seems odd to some people. For example, if you lose a finger at work, you will get a set amount, but depending on what finger you may get more than someone else who also lost a finger. The question, in this case, is whether Terry Russell, who was injured on the job, is eligible for supplemental earning benefits (“SEBs”). A SEBs award is based on the difference between the claimant’s pre-injury average monthly wage, and the claimant’s proven post-injury monthly earning capacity. Seal v. Gaylord Container Corp., 704 So. 2d 1161 (La. 1997).

In 2009, Mr. Russell was employed by the Sewage & Water Board of New Orleans (“Sewage & Water Board”), when he was unfortunately injured while opening a manhole cover. The accident caused blood clotting in his upper arm and it was later found to have caused “thoracic outlet syndrome,” which injured a vein in his upper chest. To repair the damage, Mr. Russell underwent several surgeries and procedures, one of which was to remove one of his ribs to correct the thoracic outlet vein syndrome and repair the vein stint that was placed during an earlier surgery. By April of 2012, Dr. Torrence, Mr. Russell’s main doctor throughout the ordeal determined that Mr. Russell had reached maximum medical improvement, clearing him to return to work. However, he was only cleared for sedentary work, meaning he could not use his left arm, life more than five pounds, nor work more than four hours per day.

Due to Mr. Russell’s longtime employment and good work ethic, the Sewage & Water Board offered him part-time work as a mail courier, which he declined because he would not be making his pre-injury salary. After declining the position, the Sewage & Water Board stopped making disability payments to Mr. Russell, leading to the case in question. Mr. Russell asked the Louisiana Court of Appeals (the “Court”) to overturn the Office of Workers’ Compensation calculation of SEBs that Mr. Russell is entitled. To be entitled to SEBs one must not earn 90 percent of their pre-injury wages, which Mr. Russell would not had he accepted the part-time mail courier work. See La. R.S. § 23:1221. Thus, the Court correctly held that Mr. Russell was entitled to SEBs; however, they determined that the wages he would have earned as a mail courier must be imputed to him for the purposes of calculating his post-injury earnings. La. R.S. § 23:1221.

welding-1414385-1024x683Disputes over injuries that occur on the job can be difficult to resolve for both employer and employee. Louisiana’s Third Circuit Court of Appeal addressed a common source of dispute — whether an employee’s medical condition was actually caused by his employment — in a case involving a welder who developed compartment syndrome.

Isiah Loucious began working as a welder apprentice for Crest Industries in February of 2014.  In September 2014, he filed a lawsuit against Crest alleging that beginning in April 2014, he developed an occupational disease of compartment syndrome as a result of his work activities. An occupational disease is any disease or illness that occurs due to the actions and conditions of a job. La. R.S. 23:1031.1(B). Loucious alleged that after he started working for Crest, he began to experience cramping and swelling in his right arm and hand. Crest filed a motion for summary judgment, asserting that Loucious had complained of having a weak hand grip, numbness, and tingling in both hands a number of years before the alleged the onset of compartment syndrome. A motion for summary judgment is made when a party believes that the adverse party has failed to provide evidence to show that there is a genuine issue of material fact in dispute. Loucious opposed Crest’s summary judgment motion, relying on a medical record wherein the physician, Dr. Raymond Beurlot, checked “yes” next to the statement:  “the compartment syndrome in the right hand/arm developed, more probably than not, during the course and scope of employment with Crest Industries, LLC.” The Workers’ Compensation Judge (WCJ) granted Crest’s summary judgment motion, explaining that nothing in the record showed that Dr. Beurlot knew the specific job functions and duties of Loucious when signing the medical record. Therefore, the record did not support Loucious’s contention that his medical condition was the result of his employment with Crest. Loucious appealed the WCJ’s ruling.

The issue for the Court of Appeal was whether the WCJ was correct in holding that the medical record signed by Dr. Beurlot did not create a genuine issue of material fact that should have precluded summary judgment. Under Louisiana law, an alleged occupational disease is presumed not to have occurred during the course of employment when the employee has performed the particular job duties for less than twelve months. La. R.S.23:1031.1(D). In order for the employee to controvert this presumption, he must provide evidence that contradicts the presumed fact. La. C.E. art. 305. That evidence should pertain to the employee’s work and life activities before the time of employment. See Davies v. Johnson Controls, Inc. A certified medical record can serve as this evidence, so long as it is prepared by the health care provider in his or her usual course of business. La. R.S.13:3715.1(E)(2).

architecture-building-fire-exit-ladders-213976-1024x683Compensation for work-related injuries can be an area of concern for both employees and employer. But what happens when the employee provides inconsistent stories that refute the injury alleged to have been suffered? The Second Circuit Court of Appeal for Louisiana recently addressed the issue.

In August 2013, Kevin Tingle (“Tingle”) began to work at Page Boiler in Louisiana. Tingle was performing job duties at when he claimed to have fallen 20 feet off a scaffold into the boiler he was cleaning while working. Tingle was then airlifted from one hospital to another because of the seriousness of his injuries. Nurses in the emergency room recorded that Tingle had fallen t and that Tingle was complaining various pains. However, the scan of Tingle’s back showed a lack of evidence that he was injured. Tingle was discharged that same day and was instructed to seeek medical treatment with another doctor.

On September 27th, 2013, Tingle visited his primary physician complaining of terrible back pain. Tingle’s mother informed the physician that Tingle was unable to feed himself due to the pain. After Tingle’s X-rays came back negative, his primary physician referred him to another set of doctors who specialize in neck and back injuries. Tingle retained a lawyer, and the lawyer then notified Page Boiler’s insurance company, Argonaut, that Tingle had selected a doctor for the physician to deal with his neck and back complaints.

entering-arkansas-1215127-1024x671Workers’ compensation provides an avenue for workers injured on the job to receive the compensation a worker deserves. But what happens when a resident of one state is injured while working for a company in another state? A recent case out of the Second Circuit Court of Appeal for Louisiana addressed this issue when a Monroe, Louisiana worker, working for an Arkansas company, was injured in Mississippi.

Levi Williams was injured in Mississippi while driving a truck for Morris Transportation, Inc. (“Morris Transportation”), an Arkansas company. After the accident, Mr. Williams applied for and was granted, workers’ compensation benefits in Arkansas. Those benefits went away after Morris Transportation released Mr. Williams from work. Subsequently, Mr. Williams sought workers’ compensation benefits in Louisiana. Morris Transportation contested Mr. Williams’s request and the matter went before a Workers’ Compensation Judge (“WCJ”). At a hearing, the WCJ ruled in favor of Mr. Williams, holding that Mr. Williams was entitled to Louisiana workers’ compensation benefits. Under Louisiana law, an injured employee is entitled to workers’ compensation when injured while working outside the state if the employment contract is made in Louisiana. La. R.S. 23:1035.1 (2016). The WCJ found that the contract, in this case, was made in Louisiana and therefore, Mr. Williams was entitled to Louisiana workers’ compensation benefits. Morris Transportation, disagreeing with the WCJ’s assessment, appealed the decision.

On appeal, the Second Circuit Court of Appeal examined whether the employment contract between Mr. Williams occurred in Louisiana. Both Mr. Williams and Morris Transportation dispute the facts surrounding the formation of the employment contract According to Mr. Williams, he previously worked for Morris Transportation, but left to work for another employer. A little while after Mr. Williams left Morris Transportation, he called Morris Transportation and was told by an employee that he could come back and work for his former employer. Mr. Williams claimed that during this call he was told by by Morris Transportation that he could “come back.” Mr. Williams testified that the day after the phone call he drove, signed a driver qualification form, and began to working. Morris Transportation, conversely, argued that the phone conversation between Mr. Williams and itself did not form a contract. It claimed that the phone conversation could not constitute an employment contract because Mr. Williams had not gone through the employment process required before Morris Transportation hires an employee.

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