Tangipahoa Sawmill Lawsuit Discusses Medicare Set-Asides and What Can Happen To Non Cooperative Litigants

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.

Therefore, in this case, Mr. Williams, Cypress Sawmill and its self-insured fund, Louisiana Commerce and Trade Association (LCTA),initially agreed on a settlement of the amount to be paid back for his workers compensation benefits paid out of the settlement of his case against the third party.   After doing so they filed a joint petition for approval of a workers’ compensation settlement on April 5, 2012. The settlement terms included a lump sum from Mr. Williams’s tort settlement to Cypress Sawmill and LCTA for reimbursement for workers’ compensation payments made to Mr. Williams. The settlement term also included a Medicare set-aside to be submitted to the Center for Medicare Services (CMS) to calculate a Medicare set-aside allocation (MSA) in order to reimburse Medicare from the tort settlement funds for the payments that Medicare made on behalf of Mr. Williams.

The order that would have approved the settlement and dismissed Mr. Williams’s workers’ compensation claim was initially denied. The petition and order were then amended to include specific language about the settlement amount and the MSA analysis that was lacking in the original order. On April 19, 2012, the OWC signed the amended order, dismissing Mr. Williams’s claim for compensation with prejudice.

CMS then requested additional information in order to review the set-aside amount. LCTA filed a rule to enforce judgment on December 14, 2012, claiming that Mr. Williams would not execute the General Release of Information medical consent form that CMS requires in order to authorize the analysis. CMS then rejected the analysis for lacking documentation of Mr. Williams’s medical history. On February 19, 2013, Mr. Williams was ordered by the OWC to cooperate with LCTA by providing the authorization required to release his medical records so that the MSA analysis could be completed, and for Mr. Williams to authorize the analysis when it was completed.

Mr. Williams did provide some of his medical history, but CMS considered the information to be insufficient to improve the accuracy of the MSA analysis and closed its file due to the lack of documentation of Mr. Williams’s medical history. LCTA filed a motion to file and attach the MSA analysis to the settlement on November 19, 2013. The MSA analysis was the only analysis available for submission to the OWC, and the OWC denied the motion on November 25, 2013. On February 10, 2014, the OWC again ordered Mr. Williams to cooperate with LCTA by providing whatever information and authorization was necessary to reach a settlement.

On July 18, 2014, the LCTA filed a motion to file and incorporate an approved MSA analysis into the settlement documents, claiming that Mr. Williams had agreed to a set-aside amount of $61,308.00, which was approved by CMS. Following a hearing on August 22, 2014, the OWC ordered, over Mr. Williams’s objection, that the MSA determined by CMS be incorporated into the settlement. Mr. Williams stated at the hearing that MSA was based on incorrect analysis, making the MSA incorrect.

Unhappy with the trial court’s decision Mr. Williams decided to appeal to the Louisiana First Circuit Court of appeal.  Mr. Williams cited two assignments of error on appeal. First, Mr. Williams alleged that the OWC erred in incorporating the incorrect MSA analysis into settlement. Second, Mr. Williams asserted that if the OWC finds that he does need $61,308.00 in future medical care, the joint petition for settlement should be set aside and the OWC case re-opened for proceedings to determine if the prior settlement was a mistake of fact.

In workers’ compensation cases, the appropriate standard of review to be applied by appellate courts is the manifest error-clearly wrong standard. Smith v. Lafarge North America, L.L.C., 2012-0337 (La. App. 1 Cir. 11/2112), 111 So.3d 379, 382. The court found that the OWC did not abuse its discretion in incorporating the approved MSA analysis into the settlement agreement between Mr. Williams and LCTA. The court affirmed the order of the OWC to incorporate the analysis into the settlement. The court held that Mr. William’s refusal to cooperate delayed the resolution of the case for two years.  The appellate court could find no reason to delay the termination of this case for any longer, especially when the plaintiff was being so obstructive.  As to his second reason for appealing for reasons unknown Mr. Williams did not even bother to brief that argument so the appellate court decided it had been abandoned.

This case shows that courts do not take kindly to litigants who don’t cooperate.  While we don’t know why Mr. Williams was not more cooperative with the various request for information this case makes it clear that it is better to follow court’s orders than complain about the results of noncompliance later.


Written by Berniard Law Firm Blog Writer: Kevin Watts

Additional Berniard Law Firm Articles on Workers Compensation Issues: Workers Comp Case Involves Settlement Dispute, Rights Review

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