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Category: Workers Compensation

  • Understanding Statutory Employer Immunity in Workers’ Compensation Cases in Louisiana

    Statutory employer immunity is critical in determining liability and compensation for workplace injuries in workers’ compensation. The following case is an example where the court had to decide whether the defendant was entitled to statutory employer immunity under the dual contract theory provided for in La.R.S. 23:1061(A)(2). We will examine the facts of the case, the arguments presented by both parties and the court’s decision. We will also examine the legal framework surrounding statutory employer immunity and its impact on workers’ compensation cases.

    The case involves Patrick Cummins, a worker hired by a subcontractor to perform its contract with R.A.H. Homes and Construction, LLC (“R.A.H.”), the defendant. The homeowners had contracted R.A.H. to construct a single-family home, including the installation of an attic HVAC system. Cummins became seriously injured when the attic access ladder malfunctioned, and he fell while performing the work required under R.A.H.’s contract with the homeowners.

    Cummins sued several defendants, including R.A.H., in tort, alleging that R.A.H. was directly responsible for the improper installation of the attic ladder that led to the accident. In response, R.A.H. asserted an affirmative defense of statutory employer immunity under La.R.S. 23:1061(A)(2), claiming that a statutory relationship existed through the two-contract theory.

    The two-contract theory allows a contractor (in this case, R.A.H.) to claim statutory employer immunity if it entered into two separate contracts: one with the homeowner and another with the subcontractor performing work on the project. For this defense to apply, the work or services provided by the subcontractor must be contemplated or included in the contract between the principal and the homeowner.

    Cummins argued that R.A.H. was not his statutory employer under La.R.S. 23:1061(A)(3) because no written contract expressly recognized R.A.H. as his statutory employer. However, the court disagreed, citing the dual-contract theory and the absence of a written contract requirement under La.R.S. 23:1061(A)(2). It emphasized that R.A.H. had two separate contracts – one with the homeowners and another with the subcontractor, United, for whom Cummins worked. Because the work performed by United was provided for in the contract between R.A.H. and the homeowners, the court found a statutory relationship between R.A.H. and Cummins.

    Statutory employer immunity is essential to workers’ compensation laws, ensuring that workers injured on the job receive compensation while limiting employers’ liability. By providing exclusive remedy protection, the law aims to avoid lengthy tort litigation and to facilitate a more efficient and streamlined resolution of workers’ compensation claims.

    The Louisiana Third Circuit Court of Appeal affirmed the trial court’s decision and upheld R.A.H.’s entitlement to statutory employer immunity under the two-contract theory. The case is a valuable example of how statutory employer immunity works in workers’ compensation cases, highlighting the importance of contracts and the interplay between the parties involved. As statutory employer immunity laws can vary from jurisdiction to jurisdiction, it is important to understand the specific provisions applicable in a given case to ensure a fair and equitable resolution for all parties involved.

    Additional Sources: APPEAL FROM THE FIFTEENTH JUDICIAL DISTRICT COURT PARISH OF LAFAYETTE, NO. C-2016-4264

    Written by Berniard Law Firm Blog Writer: Oprah Jerome

    Other Berniard Law Firm Articles on Workers Compensation: Should an employer continue to pay Workers’ Compensation Benefits even after an employee has fully recovered?

  • When is a Parent Company Responsible for the Safety of its Subsidiaries?

    When an individual sustains an injury while on the job, the anticipation of receiving workers’ compensation to tide them over during their recovery is natural. Regrettably, situations arise where companies are unwilling to shoulder this responsibility. The scenario becomes more intricate when a parent company distances itself from its subsidiary’s actions, attempting to evade liability for workplace injuries. This particular Louisiana Court of Appeals case delves into corporate responsibility, illuminating the circumstances under which a parent company is held accountable for the safety measures enacted by its subsidiary entities.

    Plaintiff, Truman Stanley, III, had his arm tragically severed at work when a defective oxygen cylinder exploded, and steel fragments broke off. He filed a personal injury lawsuit against Airgas USA seeking tort recovery. He later amended his complaint to include Airgas Inc., the parent company of Airgas USA, claiming it developed safety procedures and protocols and instructional materials/safety training that was inadequate and flawed, creating an unsafe workplace. Therefore, Stanley believed Airgas, Inc. should be liable in tort. The parent company moved for summary judgment stating it was immune from tort liability under the Louisiana Workers’ Compensation exclusive-remedy provision. The trial court ruled in favor of the defendant and granted summary judgment. Stanley appealed, claiming the trial court erred in finding the parent company immune from tort liability.

    Louisiana Revised Statutes 23:1032 contains the exclusive-remedy provision under the Louisiana Workers’ Compensation Act, which states the employer and anyone who may act as the employer are immune parties. However, for the immunity to apply, it “must have been engaged at the time of the injury in the normal course and scope of the employer’s business.” Under Louisiana Revised Statutes 23:13, an employer’s legal duties that cannot be delegated include providing safe working conditions for employees. That being said, providing a safe work environment falls within the course and scope of every employer’s business. If the parent company took on Airgas USA’s role, Airgas Inc. would be immune from tort liability.

    However, a parent company has no duty or liability for the subsidiary’s actions and is not responsible for the working conditions. Airgas Inc. provided evidence that it had no involvement in the day-to-day management of Airgas USA. In addition, there was no evidence Airgas Inc. took over any obligation to ensure employee safety for Airgas USA. Finally, Stanley failed to prove an essential element of his claim, that Airgas Inc. assumed the duty for Airgas USA to ensure a safe work environment. The duty to show factual support to establish the existence of a genuine issue of material fact for summary judgment was shifted to Stanley, and his failure to do so led the court to uphold the trial court’s decision to grant the defendant summary judgment. 

    This case highlights the importance of when a parent company, like Airgas Inc., is responsible for the safety protocols and conditions in place at its subsidiaries. It also highlights the importance of genuine issues of material fact when it comes to summary judgment cases. Injured workers often expect workers’ compensation from their company, but it is important to understand who may be responsible for the injuries.

    Additional Source: Truman Stanley III v. Airgas, Inc. 

    Written by Berniard Law Firm Writer Alivia Rose

    Additional Berniard Law Firm Article: When Can I File a Tort Lawsuit against my Employer if I am Hurt at Work in Louisiana?

  • How do Conditions on Payments in Louisiana Workers’ Compensation Work?

    Louisiana’s Workers’ Compensation fund exists to pay employees injured at work.  Payment can be used for medical care and lost wages.  When parties sign a settlement agreement on payment terms, an employee may assume payment is imminent.  In a recent case from Rapides Parish, an employee discovered some conditions in a settlement may delay payment.  

    Mary Ortega sustained an injury while employed by Cantu Services.  Ortega filed a Disputed Claim for Compensation, and the parties entered a settlement agreement.  The parties settled for $120,000.  $56,049 of the total was allocated to a Medicare set-aside agreement (MSA) to cover future medical expenses related to the work injury. The MSA was filed with the Centers for Medicare and Medicaid Services (CMS) for approval.  The parties agreed that if CMS did not approve the full amount in the MSA, the employer would adjust the amount paid in monetary benefits, so Ortega would still receive $120,000.  Several months after signing the agreement, Ortega had not received any payments.   She filed a motion to enforce the settlement agreement plus a request for fees and penalties before the Office of Workers’ Compensation.   

    The Workers’ Compensation Judge (WCJ) denied Ortega’s request because payment under the settlement agreement was conditioned on first getting approval from the MSA.   Pending approval suspended the statutory requirement of payment within thirty days.    Ortega appealed to the Louisiana Third Circuit Court of Appeal.     

    The main issue on appeal was whether pending approval of the MSA was a condition that suspended any payments to Ortega.  Ordinarily, Louisiana law requires payment following final judgment or settlement to be made within thirty days.  However, nonpayment due to conditions over which the employer had no control prohibits nonpayment penalties.  See La. R.S. 23:1201(G). A suspensive condition suspends enforcement of an obligation until a certain event occurs.  See La. C.C. 1767.   A suspensive condition that depends solely on the whim of the obligor voids the condition.  See La. C.C. 1770.  The Louisiana First Circuit Court of Appeal found that in a case factually similar to Ortega’s, pending CMS approval of an MSA suspended, the obligation to fund the MSA account until approved.  See Harrelson v. Arcadia.  

    In Ortega’s case, the settlement agreement specifically allocated $56,049 to the MSA, contingent on CMS’ approval.  The Third Circuit agreed with the WCJ that this was a suspensive condition out of the employer’s control.  The parties agreed that if the full amount submitted in the MSA was not approved, the monetary award would be adjusted so Ortega would still receive $120,000. The Third Circuit noted as a practical matter, the employer would not know how much to disburse until CMS approved a total for the MSA monetarily.  Ortega’s attempt to enforce the settlement agreement was denied.   

    Terms of a settlement agreement must be adhered to, and an experienced lawyer can help decipher and appropriately advise on those terms.  In this case, the settlement agreement specified a condition that had to be met before payment disbursement.  A careful understanding and explanation by an excellent lawyer is required to understand conditions to payments in workers’ compensation cases.    

    Additional Sources: Mary Ortega v. Cantu Services, Inc. et. al.

    Written By: Stephanie Burnham 

    Additional Berniard Law Firm Articles on Workers’ Compensation: Is Strict Compliance With Settlement Agreement Terms Required?

  • Louisiana Court Denies Workers Compensation for Injured Minor

    Injury in the workplace can usually be avoided with proper safety measures in place. Safety measures, however, become hard to enforce when minors and adults work in conjunction. This was the case for Austin Griggs, an illegally employed minor injured in a forklift accident while working.

    Bounce N’ Around Inflatables, LLC (BNA) supplies rentable party inflatables for personal or corporate events. When not in use, the inflatables are stored on racks that are 10 feet high. To move the inflatables, a battery-operated pallet jack was required. Griggs began working for BNA at the age of 14. BNA employed about 12 minors at the time Griggs was injured. Griggs testified that he had never been told that a work permit was required to work at BNA.

    On the day of injury, Griggs was helping another employee pick up and sort the inflatables. This required Griggs to get the inflatable onto the forklift, and then the other employee would use the forklift to move the inflatable into the rack. During this process, Griggs was required to use his weight to counterbalance the inflatable as the forklift lifted the inflatable upwards. Griggs testified that this was standard practice at BNA. During the lift, Griggs fell off the forklift. Then, the inflatable followed, landing on Griggs’s lower back. 

    When Ms.Griggs picked up Griggs from work, she immediately took Griggs to Ascension Urgent Care. Griggs was diagnosed with a closed metatarsal fracture and told to seek further evaluation and treatment with an orthopedist. Thus, Ms. Griggs took Griggs to Baton Rouge Orthopedic Clinic the following morning. Ms. Griggs called the owner of BNA to confirm that Griggs could be treated with BNA’s insurance through Louisiana Commerce & Trade Association Self-Insurers’ Fund. During the call, BNA’s owner instructed Ms. Griggs not to mention the forklift usage when utilizing the insurance. Griggs was seen by a doctor who later installed fixation hardware to Griggs’s fractured foot. 

    As a result of Grigg’s injuries, Ms. Griggs filed a lawsuit against BNA and their insurer. The trial court issued a judgment, holding that Griggs was illegally employed and engaged in illegal activities at the time of injury. The trial court found that Griggs could proceed with a tort claim despite this. This holding relied upon the reasoning in Ewert v. Georgia Casualty & Surety, Co. The trial court rendered judgment in favor of Griggs for $125,000 for general damages and $ 24,517.93 for special damages, plus legal interest and all costs of the proceedings. The trial court further found that BNA’s insurer was entitled to reimbursement from Griggs for the sums paid for medical expenses, mileage, and lost wages, totaling $ 25,867.93.

    On appeal, BNA argued that the trial court’s general damages determination was an abuse of discretion and that the court improperly allowed Griggs to make a tort claim. Without the ability to make a tort claim, Griggs would be required to make a claim through the Louisiana Workers’ Compensation Act. This Act, however, would not allow Griggs to make a claim because he was illegally employed and committing an illegal act when he was injured. The First Circuit agreed with BNA and reversed the trial court’s holding. The monetary damages were reversed, and all legal fees incurred on appeal by BNA were assessed to the Griggs family. 

    Austin Griggs’s case underscores the intricate nature of legal proceedings involving minors in the workforce and the complexities of tort claims in such scenarios. The appellate litigation brought forth various aspects of the case, including the implications of Griggs’s illegal employment status on his ability to pursue claims through the Louisiana Workers’ Compensation Act. The First Circuit’s decision highlighted the importance of understanding the legal landscape and the potential consequences of both plaintiff’s and defendant’s actions. When faced with complex legal scenarios like the Griggs case, securing the guidance of a proficient attorney becomes crucial in deciphering the nuances of the law and navigating the multifaceted terrain of appellate litigation.

    Additional Sources: Griggs v. Bounce N’ Around Inflatables L.L.C. 

    Written by Berniard Law Firm Writer Riley Calouette

    Additional Berniard Law Firm Article on Workers Compensation: How Can You Get Workers Compensation When Your Employer Won’t Pay It?

  • Lafourche Parish Court Demonstrates the Importance of Employee-Employer Relationship in Workers’ Compensation Cases

    Unfortunately, accidents in the workplace are not uncommon. What happens, however, if you unknowingly signed an agreement making your employer immune from a liability claim? The following Lafourche Parish case outlines this predicament. 

    In September 2013, Neville Patterson signed multiple documents with Raceland Raw Sugar, LLC (RRS) and Raceland Equipment Company, LLC (REC) to haul sugar cane for the former. Included in this paperwork was an indemnification agreement identifying Patterson as the contractor and RES and RRS as statutory employers. 

    Two months later, Patterson created N-A-N Trucking, LLC (N-A-N) and started to operate his truck. Following this development, RRS began making checks from hauls payable to N-A-N. These checks were endorsed by Patterson, who continued to receive driver wages from REC. 

    The following month, Patterson was unloading the trailer at the RRS mill when a cable broke, forcing the trailer to fall on the truck and injure his back and neck. Patterson then filed a claim for damages, naming REC and RRS as defendants, asserting he was an employee of N-A-N, and claiming the accident that caused his injuries resulted from RRS’ and REC’s negligence. RRS and REC responded by claiming that Patterson was REC’s direct employee and RRS’ statutory employee, barring his claims via the Louisiana Workers’ Compensation Act. 

    The 17th Judicial District Court for the Parish of Lafourche denied the motion submitted by RRS and REC, noting conflicting evidence on whether Patterson was a direct employee of REC and inconsistent evidence on whether the indemnification agreement showed that he was N-A-N’s employee or a contractor with REC and RRS. REC and RRS then renewed their motion for summary judgment. 

    In their renewal, RRS and REC claimed that Patterson was an independent contractor of both companies via a written agreement compliant with Louisiana law, conveying statutory employer status on RRS and REC and making them immune from civil tort liability. Patterson then argued that he was an employee of N-A-N and no contract existed between RRS and N-A-N. 

    The District Court then dismissed Patterson’s claims and granted summary judgment, finding the indemnification agreement signed by Patterson demonstrated a rebuttable presumption of a statutory employment relationship. The court also found Patterson, who had the burden of proving the relationship was severed when he formed N-A-N, failed to deliver any proof the contract was revoked under law. Patterson then filed an appeal with the Louisiana First Circuit Court of Appeal. 

    Under La. R.S.23:1061, a statutory employer relationship does not exist unless a written contract between the principal and a contractor recognizes the principal as the statutory employer. Additionally, the contractually recognized relationship can be overcome by showing the work performed was not an integral or essential part of the generation of the principal’s goods, products, or services. Further, the employer seeking to avail itself of tort immunity holds the burden of proving it. See Fleming v. JE Merit Constructors, Inc.

    The Court of Appeal found that Patterson entered into an indemnification agreement in his capacity, which listed him as a contractor. Additionally, because the agreement recognized RRS and REC as statutory employers and Patterson as an owner/operator, the Court of Appeal found it was unnecessary to enter into an additional contract following the formation of N-A-N. Next, as the court found the agreement between Patterson and RRS and REC conveyed a statutory employer status, there existed a rebuttable presumption of a statutory employer relationship. The Court of Appeal found Patterson failed to deliver proof to rebut this presumption by showing that hauling sugar cane to a sugar mill was not crucial to the ability of the principal to produce its products, goods, or services. As such, the District Court’s judgment was affirmed. 

    This case shows the importance of hiring an experienced attorney to review all employee-employer documents before signing them, as you may be entering into a relationship agreement that would bar you from receiving compensation in the case of an accident. The right attorney can also help you provide the evidence necessary to prove your lawsuit.  

    Additional Sources: NEVILLE PATTERSON VERSUS RACELAND EQUIPMENT COMPANY, LLC AND RACELAND RAW SUGAR LLC D/B/A RACELAND SUGAR MILL

    Written by Berniard Law Firm Blog Writer: Samantha Calhoun

    Additional Berniard Law Firm Articles on the Importance of Evidence in Workers’ Compensation Lawsuit: Workers’ Compensation Lawsuits and the Battle for Evidence — Louisiana Personal Injury Lawyer Blog

  • Workers’ Compensation Settlements: Protecting Your Social Security Benefits and Rights

    Settling a lawsuit can have many far-reaching effects. Not only will it result in the dismissal of your lawsuit, but it could also affect things such as your social security benefits. Therefore, it is important that you consult with an attorney and carefully consider if a settlement is in your best interest. Additionally, as seen in this case, if you accept a settlement offer, you must ensure the related court order includes all required aspects so you do not have to deal with unintended consequences. 

    Kenneth Clark and his employer, Walgreens, reached a settlement related to Clark’s workers’ compensation claim. A workers’ compensation judge approved the settlement and entered a judgment dismissing the claim. Clark then petitioned the workers’ compensation judge to amend the judgment to include language to divide the indemnity part of his settlement across his lifetime. This proposed amendment would not change the total amount of the settlement. Clark wanted this amendment so the Social Security Administration could pro-rate the settlement so it could calculate the required disability offset. Walgreens objected to this amendment. After a hearing, a workers’ compensation judge entered an amended order reflecting Clark’s requested language. Walgreens appealed. 

    On appeal, Walgreen argued the trial court did not have jurisdiction to amend the initial order approving Clark’s settlement with Walgreens. La. R.S. 23:1272 governs the settlement of workers’ compensation claims. This statute has many safeguards for preventing an employee from being pressured to improperly settle his or her claim. Courts are to liberally construe workers’ compensation law in favor of workers to protect them from the burden of workplace injuries. 

    Clark subsequently requested the court amend the initial order of approval because his counsel had not advised him to request language related to the indemnity portion of the settlement, which the Social Security Administration requires. Under La. C.C.P art. 1951, a judgment can be amended to alter the phrasing if it does not alter the judgment’s substance. Here, the purpose of amending the judgment was to include the language the Social Security Administration required. The amendment did not affect Clark’s or Walgreens’ rights or obligations and did not add anything substantive to the order. The added language would assist the Social Security Administration in determining its offset from Clark’s settlement.  Because the amendment just changed the phraseology and not the substance of the order, the appellate court disagreed with Walgreens’ argument the court did not have jurisdiction to amend the initial order.

    As seen here, many unique requirements exist for settling a workers’ compensation claim. If you are involved in a workers’ compensation dispute, it is important to consult with a good attorney who can advise you on possible paths forward. It is especially important to consult with an attorney if you are considering a possible settlement of your workers’ compensation claim. A good attorney can help review the settlement and associated court order to ensure it is in your best interest and contains all required aspects. 

    Additional Sources: Kenneth Clark v. Sedgwick CMS, et al.

    Article Written By Berniard Law Firm

    Additional Berniard Law Firm Article on Amended Judgments: A Louisiana Court Signs Two Final Judgments, What Happens?

  • Can An Independent Medical Examiner Determine Maximum Medical Improvement in a Worker’s Compensation Case?

    Being injured at work is never what you want to deal with. What’s worse is dealing with multiple independent medical examiners making opinions on your medical state. In the following case, the Louisiana Court of Appeal First Circuit addresses whether a medical examiner’s determination of maximum medical improvement is closely related to the worker’s condition and ability to work.

    Ella Hamilton injured her neck and shoulders while moving trash bags into a dumpster while working as a custodian for GCA Services. Hamilton filed a workers’ compensation claim, and GCA Services paid indemnity and medical benefits to and on behalf of Hamilton in connection with her workers’ compensation claim. A dispute arose between the doctors that reviewed Hamilton’s alleged injuries and whether or not he could return to work.

    Dr. Charles Bowie, a neurosurgeon, diagnosed Hamilton with a cervical disc disorder and opined that she required cervical fusion surgery. He believed her injuries prevented her from working. On the other hand, Dr. David Ferachi, an orthopedic surgeon representing GCA Services, agreed with Dr. Bowie but stated that Hamilton could return to work as a custodian with certain limitations.

    Due to these differing opinions on Hamilton’s ability to work, GCA Services filed a request for Independent Medical Examiner (“IME”) under La. R.S 23:1123. This request was granted. Hamilton asked that the workers’ compensation judge prohibit the medical examiner from addressing any other issues, such as his medical condition, causation, maximum medical improvement, and whether medical treatment is reasonable and necessary. The judge agreed with Hamilton and limited the IME to address Hamilton’s capacity to work. GCA took an appeal of the order.

    The Court of Appeal First Circuit disagreed with the District Court and held that under La. R.S 23:1123, the “condition of the employee” does include maximum medical improvement. This means the scope of the examination the independent medical examiner may address includes the issue of maximum improvement. The Court explained that because the maximum medical improvement is closely related to condition and ability to work, the medical examiner can determine the maximum medical improvement of Hamilton in this case without having to show what the cause of injury was.

    The Louisiana Court of Appeal First Circuit also noted the scope of the independent medical examination should not be limited, per Hamilton’s claim. This is because the independent examiner can provide an opinion of the necessary information without revealing the actual causation of those injuries during an IME. Therefore, the Appeals Court partially reversed the trial court’s ruling to the extent that it restricted the independent medical examiner from determining maximum medical improvement. 

    While each case should be carefully analyzed based on specific facts, this court ruling answered whether the scope of an independent medical examination could be limited in workers’ compensation cases. The answer, in this instance, was determined to be yes.

    Additional Sources: ELLA HAMILTON VS. GCA SERVICES GROUP, INC. 

    Written by Berniard Law Firm Writer Brianna Saroli

    Additional Berniard Law Firm Articles on Workers Compensation: While Injured Worker Claims Late Payment, Louisiana’s First Circuit Court of Appeals Focuses on Important Date & Workers Compensation

  • Understanding the Impact of Settlement on Workers’ Compensation Benefits in Louisiana

    Suppose you are considering settling a lawsuit related to injuries on the job. In that case, it is essential to understand how a potential settlement of a related claim could affect your workers’ compensation benefits. What happens to your workers’ compensation benefits if you settle a related lawsuit without written approval from your employer and their workers’ compensation insurer? The following case helps answer that question.

    While working at Mouton Plumbing, Terrell Talbot was involved in a car accident. Mouton Plumbing and its workers’ compensation insurer accepted Talbot’s claim under La. R.S. 23:1021. He received $69,265.02, consisting of workers’ compensation indemnity benefits of $23,487.86 and medical expenses of $45,777.16. Talbot filed a lawsuit against the other individual involved in the car accident and her insurer. Pursuant to La. R.S. 23:1102(A), Talbot notified Mouton Plumbing and its insurer in writing about the lawsuit. They intervened in Talbot’s case. Talbot settled the lawsuit for $107,389,73 but did not obtain written approval from Mouton Plumbing or its insurer. As a result, the insurer ended Talbot’s workers’ compensation benefits. 

    Under La. R.S. 23:1102(B), a worker is not entitled to workers’ compensation benefits if he does not obtain the employee or insurer’s approval to settle a related lawsuit. However, an employee can reclaim his workers’ compensation benefits through a “buy-back provision.” When Talbot’s benefits were terminated, a lien from Mouton Plumbing’s insurer was not satisfied. As a result, the $28,730.84 due to Talbot from the settlement, after deducing attorney’s fees and costs, was paid directly to the insurer to satisfy the lien. 

    Talbot claimed that payment satisfied the buy-back provision. Mouton Plumbing and its insurer claimed this payment did not fully “buy back” Talbot’s workers’ compensation benefits. All the parties filed summary judgment motions. The workers’ compensation judge held the $28,730.84 payment restored Talbot’s workers’ compensation benefits. However, Mouton Plumbing and its insurer were entitled to additional credits against Talbot’s future benefits. Mouton Plumbing and its insurer appealed, arguing that the trial court erred in calculating the “buy back” amount and finding the “buy back” was satisfied. 

    Because the appellate court had to interpret applicable statutes, it reviewed the trial court’s conclusions to see if they were legally correct. Here, the trial court correctly applied  La. R.S. 23:1102(B) in subtracting Talbot’s attorney fee from the lien amount paid to Moulton Plumbing’s insurer. However, the trial court erred in the amount of attorney fees it deducted. Because of this error, the trial court adjusted Talbot’s award to reflect a credit of $2,421.71. Otherwise, the appellate court agreed with the trial court’s award. 

    The appellate court explained the trial court correctly determined Talbot’s buy-back payment would not exceed the 50% statutory cap. The appellate court refused to consider other new arguments the parties raised on appeal related to the trial court’s calculation of the buyback amount.

    Talbot argued the trial court erred by not including the amounts of medical bills paid by his attorney that he claims Moulton Plumbing should have paid. The appellate court found this was a genuine issue of material fact about whether these bills were incurred due to Talbot’s injury. Therefore, the appellate court remanded the case back to the workers’ compensation court to determine that issue. 

    Settling a lawsuit related to work-related injuries without obtaining written approval from your employer and their workers’ compensation insurer can result in the termination of your benefits. This case serves as a reminder of the importance of seeking legal advice to navigate the complexities of settlement and protect your rights. Consulting with an experienced attorney is essential to ensure compliance with legal requirements and maximize the potential benefits from your workers’ compensation claim.

    Additional Sources: Terrell Talbot v. Mouton Plumbing and Hauling, lnc. and Liberty Mutual Ins. Co.

    Additional Berniard Law Firm Article on Settlements involving Workers’ Compensation Claims: Louisiana First Court of Appeal Illustrates How Settlement of Claims is Res Judicata Between Litigants in Tangipahoa Workers Compensation Lawsuit

  • Navigating the Insurance Maze: Timing is Key for Administrative Remedies

    The process of filing insurance claims can be time-consuming, demanding careful attention from all parties involved. In a recent ruling by the First Circuit Court of Appeal in Louisiana, the importance of timely and exhaustive pursuit of administrative remedies before seeking judicial review in insurance payment disputes was underscored. The case of Southern Framers of Louisiana, LLC (Southern Framers) sheds light on the consequences of premature legal action, emphasizing the need to explore alternative avenues, such as administrative proceedings, before resorting to the courts. Through an examination of Southern Framers’ dispute with a healthcare provider, this ruling serves as a valuable reminder for future litigants to exhaust administrative remedies diligently and consider the proper timing and procedures in pursuing legal recourse.

    After Rafael Diaz (Mr. Diaz) injured his shoulder during the scope of his employment with Southern Framers, he underwent rotator cuff surgery which Dr. Richard Texada performed at Doctor’s Hospital of Slidell d/b/a Sterling Surgical Hospital (Hospital). Following Mr. Diaz’s surgery, the Hospital sent a bill for $33,133.41 to Southern Framers’ insurance carrier Louisiana Homebuilders Association-Self Insured Fund (Carrier). On behalf of Southern Framers, the Carrier paid $8,887.80 to the Hospital, indicating what they believed was a “reasonable reimbursement for services” in Mr. Diaz’s surgery. As a result, the Hospital filed an administrative review according to their rights within Louisiana Administrative Code Title 40, pt. I, § 5149 (Title 40), for this underpayment of the Hospital’s services.

    Neither Southern Framers nor the Carrier responded to the administrative review. Instead, they filed a “Disputed Claim for Compensation” with the Office of Workers’ Compensation (OWC), stating that the unpaid portion of the original $33,133.41 bill was unreasonable. Southern Framers took this claim further, alleging that even the $8,887.80 previously paid to the Hospital by the Carrier was an overpayment and demanded reimbursement. The Hospital responded to the OWC complaint, raising multiple objections, including prematurity, and disputing the claims for reimbursement. At the hearing, the OWC judge sustained the Hospital’s prematurity objection, finding that Southern Framers and the Carrier failed to follow the administrative remedies of Title 40. The OWC judge called this claim “an attempt to circumvent the procedure that’s supposed to streamline and make the payments go quicker and faster without going through the hearing process.”

    Southern Framers subsequently appealed the OWC decision, arguing that the administrative remedies in Title 40 are limited to the healthcare provider and are thus not available for the employer-payor. Based on this, Southern Framers claimed that the OWC committed a reversible error in dismissing its claim for failure to follow the Title 40 remedies. After reviewing Southern Framer’s arguments on appeal, the First Circuit Court acknowledged the provider verse payor distinction in Title 40, which indicates that the payor has no independent entitlement to seek administrative review. However, the First Circuit Court pointed out that the Hospital has invoked its right to pursue administrative remedies. So, the First Circuit Court concluded that judicial review of Southern Framers’ claims before an administrative review would “thwart the purpose” of the Title 40 remedies. Moreover, Southern Framers’ claims could eventually be resolved through administrative proceedings. Therefore, the First Circuit Court affirmed the OWC decision to grant the Hospital’s prematurity objection.

    Of note to future litigants, this decision highlights the importance of diligently attempting to resolve claims through alternative means, like administrative proceedings, before heading to court. Courts may be unwilling to hear claims that are premature or untimely in some other manner, so proceed accordingly.

    Additional Sources: SOUTHERN FRAMERS LOUISIANA, LLC VERSES DOCTORS HOSPITAL OF SLIDELL DBA STERLING SURGICAL HOSPITAL AND RAFAEL DIAZ (EMPLOYEE)

    Written by Berniard Law Firm Blog Writer: Gina McKlveen

    Other Berniard Law Firm Articles on Prematurity: What is a ‘dilatory exception for prematurity,’ and how does it change the course of a case or controversy? 

  • Office of Workers’ Compensation Exceeded Authority By Shortening Prescription Period

    Navigating bureaucracy and red tape is a common experience when dealing with government agencies and trying to obtain workers’ compensation benefits. However, if you find yourself frustrated by what seems like an improper requirement, you might be able to challenge an administrative agency’s actions as exceeding its authority, as Calvin Arrant did here. 

    While working at Wayne Acree PLS, Arrant was involved in an accident where a truck that ran a red light hit his vehicle. Arrant consulted an attorney and then met with an orthopedic surgeon because he started having back pain that went down his legs. The doctor recommended an MRI. 

    His attorney contacted Acree’s workers’ compensation carrier to determine if it would agree to cover the MRI. Twice, Arrant requested approval for the MRI from the medical director under La. R.S. 23:1203.1. Both times, the medical director denied Arrant’s request via fax. 

    Arrant filed a Disputed Claim for Compensation with the Office of Workers’ Compensation (“OWC”) to review the medical director’s denial of his request for the MRI. Wayne Acree and its workers’ compensation carrier filed an exception of prescription, claiming Arrant failed to appeal the decision within 15 calendar days of receiving the denial from the medical director. The OWC ruled in favor of Wayne Acree, finding that Arrant had not timely filed his appeal within the required 15 calendar days (called the prescription period). The Louisiana Second Circuit Court of Appeal affirmed the decision in favor of the defendants. Still seeking to remedy the problem, Arrant appealed to the Louisiana Supreme Court.

    The Louisiana Supreme Court considered whether the medical director exceeded the authority the Louisiana Legislature delegated to it by creating a 15 calendar day period for an injured worker to appeal the denial of a request for medical treatment. The Court first considered whether the statute that created the OWC (La. R.S. 23:1291) provided the medical director with authority to implement a 15 calendar day period for an injured worker to appeal a medical director’s finding. The statute did not explicitly provide this authority. 

    The Court explained the Louisiana Legislature has the authority to establish time limits for someone to bring a legal claim. See La. C.C. art. 3457. Under La. R.S. 23:1203.1, the OWC has statutory authority to create rules to provide the standard medical treatment for injured workers and a process for an injured worker to request different treatment and appeal a denial of that request. However, the Legislature already created a prescriptive period for bringing claims like Arrant’s related to medical benefits in La. Rev. Stat 23:1209, the OWC did not have the authority to create and enforce a shorter prescriptive period. 

    Therefore, the Louisiana Supreme Court found that the hearing officer erred in sustaining the defendants’ peremptory exception of prescription and remanded for the Office of Workers’ Compensation to evaluate Arrant’s claim that the medical director did not appropriately apply medical treatment guidelines when he denied Arrant’s request for an MRI of his spine. 

    As demonstrated by Arrant’s case, it is possible to challenge administrative agencies that exceed their authority. The Louisiana Supreme Court’s ruling sheds light on the importance of understanding the boundaries of agencies such as the Office of Workers’ Compensation (OWC) and seeking legal counsel to navigate the workers’ compensation scheme effectively. If you are entangled in a similar situation, consulting with an experienced attorney becomes crucial to explore potential remedies and protect your rights.

    Additional Sources: Calvin Arrant v. Wayne Acree PLS, Inc. & Louisiana Workers’ Comp. Corp.

    Additional Berniard Law Firm Article on Prescription Periods: Trial Court Decision Overturned Due to Prescription Period Expiring