Court Affirms Decision for Employer to Pay Injured Employee’s Surgery under Longshore and Harbor Workers’ Compensation Act

container-barge-1238820-1024x321The fate of a claim brought under the Longshore and Harbor Workers’ Compensation Act (“LHWCA”) is often determined based upon the weight the Administrative Law Judge (“ALJ”) gives certain evidence. But how should the ALJ weigh conflicting evidence from different sources? This question was recently addressed by the United States Fifth Circuit Court of Appeals in Petron Industries Inc. v. Courville.

Ryan Courville suffered injuries to his thoracic spine while lifting equipment aboard a barge. Because of how Mr. Courville sustained his injury, he was eligible for compensation under the LHWCA. Soon after the injury, Mr. Courville sought medical treatment from multiple different doctors in an effort to alleviate the pain caused by his spinal injury. His initial treating physician recommended physical therapy but did not think surgery was necessary at the time. Mr. Courville, because of his continued pain, sought a second opinion. Mr. Courville’s second physician recommended more physical therapy and prescription medication. Still experiencing pain, Mr. Courville sought a third opinion. Mr. Courville’s third physician, a pain management specialist, tried additional physical therapy, which proved equally unsuccessful. Mr. Courville was then referred back to his second physician who ultimately recommended surgery.

Under the LHWCA, “[o]nce an employee establishes that his injury was work-related, he is entitled to all reasonable and necessary medical expenses related to that injury.” Amerada Hess Corp. v. Director, 543 F.3d 755, 761 (5th Cir. 2008) (citing 33 U.S.C.A. § 907 (2015)). Mr. Courville asked for Petron Industries and American Home Insurance’s (collectively, “the Petitioners”) to pay for the surgery pursuant to the LHWCA. Disagreeing that surgery was necessary, the Petitioners sought additional medical opinions. The Petitioners’ first physician opined that it was “more likely than not” that surgery would be needed. The Petitioners’ second physician stated that surgery would not be needed and that Mr. Courville could return to a “medium duty” job.

The disagreement over the surgery resulted in Mr. Courville filing a lawsuit and appearing before an ALJ. Because of conflicting opinions from the doctors, the ALJ appointed an independent medical expert to evaluate Mr. Courville’s injury. The independent doctor diagnosed Mr. Courville with thoracic disc degeneration but did not recommend surgery because Mr. Courville had reached maximum medical improvement. Because Mr. Courville’s treating physician recommended surgery, that treating physician’s recommendation was reasonable and necessary, and that seven years of alternative treatments were unsuccessful, the ALJ held that the surgery was necessary.

The Petitioners appealed the decision to the Fifth Circuit Court of Appeals for the United States. On appeal, the Petitioners argued that the ALJ erred in giving more weight to the testimony of the treating physician’s medical opinion. The Fifth Circuit disagreed. It held that the ALJ could give more weight to the testimony of the treating physician than the testimony of other doctors. See Black & Decker Disability Plan v. Nord, 538 U.S. 822, 830 n.3 (2003). Thus, the Fifth Circuit affirmed the ALJ’s decision.

Mr. Courville’s case reiterates the importance of continuing to pursue your right to medical treatment even if your employer or insurance company wrongfully denies your claim. When injured on the job, it is important to contact a good attorney who is experienced in workers’ compensation matters to help you protect your rights and recover fully from your injuries.

Additional Sources: PETRON INDUSTRIES, INCORPORATED; AMERICAN HOME ASSURANCE COMPANY, VERSUS DIRECTOR, OFFICE OF WORKERS’ COMPENSATION PROGRAMS, UNITED STATES DEPARTMENT OF LABOR; RYAN COURVILLE

Written by Berniard Law Firm Blog Writer: Malcolm J. MacLaren

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