Company Loses Workers Compensation Denial in Ouachita, Louisiana when Plaintiff’s Medical Records Show Truth

portal-2-1204680-1024x680What happens when an accident happens at the workplace? Well, you would immediately head to the doctor. You would rely on your medical records to show the truth when you talk to your insurance company. However, what happens when the medical administration doesn’t agree that your medical records are demonstrative of the truth? Strengthening your case against corporations that attempt to veil the importance of your medical records requires the very best attorneys possible.

Plaintiff James Arness Thomas was a forklift operator for Marsala Beverage Company. In November 2010, Mr. Thomas fell off of his forklift when a truck driver pulled forward unexpectedly. The defendant, Marsala Beverage Company, never disputed that the accident occurred in the course of the plaintiff’s employment and that he was injured.

At the time of his injury, the plaintiff suffered damage to his neck, back, arms, and wrists. Mr. Thomas returned to work temporarily, and then stopped working. The Marsala Beverage admitted that he was temporarily disabled, and paid Mr. Thomas compensation and medical benefits. In the meantime, Mr. Thomas consulted a long line of specialists, including orthopedists and neurosurgeons.

Unfortunately, Mr. Thomas’s symptoms of pain did not improve with medication after his initial consultation. In 2011, he received injections which provide pain relief for a few days. At this time, his physician requested LUBA, Marsala Beverage’s insurer, to insure Mr. Thomas’s additional injections. LUBA refused to cover the additional injections.

LUBA recommended a physician, who conducted an impairment evaluation of Mr. Thomas. In 2012, Mr. Thomas underwent another impairment evaluation. According to the physician, Mr. Thomas’s range of motion was only moderately restricted, and that he should be able to return to a wide variety of work activities with no restrictions.

In 2013, Mr. was diagnosed with a cervical strain with mild radiculopathy. Physical therapy proved to be ineffective because of previous swelling and high blood pressure that he had experienced. He was also diagnosed with carpal tunnel syndrome that same year. Towards the end of 2013, Mr. filed a dispute claim for compensation to see a physician. LUBA approved the referral, apparently.

In early 2014, Mr. still didn’t feel relieved of his pain. He thought he would benefit from an epidural steroid injection (ESI). Mr. Thomas requested LUBA for coverage, which was denied. LUBA denied the injection because it opined that the injection was for a “diagnostic purpose” and not for treatment. Mr. Thomas then appealed to the Associate Medical Director (AMD) of the Office of Workers Compensation (OWC).  Both the AMD and the OWC issued a letter denying the injection to Mr. Thomas.

Later, the Workers Compensation Judge determined that the AMD’s decision was not in accordance with the provisions of La. R.S. 23:1203:1. The Judge employed the “clear and convincing” evidentiary standard for the burden of proof. This standard is higher than the “preponderance of the evidence” or more likely than not standard.

The Louisiana Second Circuit Court of Appeal reviewed the case using a two party inquiry. It first considered whether there was a reasonable factual basis for the Trial Court’s finding. It then considers whether the record establishes that the finding is clearly wrong. See Stobart v. State through Dep’t of Transp. & Dev., 617 So. 2d 880 (La. 1993).

The Second Circuit noted that the Workers Compensation Judge examined the medical records over three years, and considered a physician’s deposition. The physician, Dr. Forte, had diagnosed the Mr. Thomas with the lumbar facet joint syndrome. Dr. Forte proposed the injection to relieve his pain.  The Court of Appeal affirmed the decision in favor of Mr. Thomas. It ordered that LUBA gives the injection to him and assigned the costs of appeal against Marsala Beverage.

Accidents at the workplace are difficult to handle, especially when there is a slew of medical charges and treatments that follow the accident. To protect yourself, hire the best attorney possible to thoroughly examine your medical record for your benefit.

Additional Sources: JAMES ARNESS THOMAS VERSUS MARSALA BEVERAGE COMPANY

Written by Berniard Law Firm Blog Writer: Smriti Krishnan

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