Articles Posted in Workers Compensation

Have you ever been tempted to take a sick day, just because you need a break? Have you ever called in or left early because you are feeling under the weather and you would not be able to forgive yourself if you exposed the entire office to the bug you caught? Although many employees may stretch the truth on sick days sometimes, there are occasions where it becomes irresponsible and unprofessional. One Louisiana man attempted to test the boundaries of worker compensation when he requested medical payments for his sickness. So, how can you determine if someone is faking symptoms in a workers compensation case? 

This case involves a man filing a workers compensation claim against his former employer. The employee’s name is Remco Leidelmeijen, and he was working for the company, Ferncrest Manor Nursing Home, as a licensed practical nurse. One day, while performing his work duties, he entered a patient’s bathroom to empty out a catheter bag and slipped on water that was on the floor. As a result of the slip, Leidelmeijen first fell forward, hitting his face and jaw on the sink, and then he fell backward and hit the back of his head on the floor. Immediately after the accident occurred, he declined a request to call an ambulance and instead had a family member bring him home from work. He went to the emergency room later that day and received treatment for head trauma occurring at work, according to the emergency room records. He allegedly had injuries for his head, his mouth, and his teeth. Therefore, Leidelmeijen filed suit in hopes of paying the medical bills he accrued for treatment of injuries that he claims came from the accident. Ultimately, he ended up with partial relief.

Leidelmeijen’s only dispute was for his claim of medical benefits, which is what was tried in front of Judge Robert Varnado, Workers’ Compensation Judge of District Eight. This court ultimately found that Leidelmeijen failed to prove entitlement to medical benefits. The majority of the medical expert testimony introduced into evidence found that Leidelmeijen did not have the brain injuries he claimed from the accident but is instead malingering. A malingering diagnosis means that the person might be deliberately or consciously feigning symptoms for an ulterior purpose (e.g., avoiding work, receiving money, prolonging illness with the intent to avoid responsibility and so on, and/or obtaining medications). Leidelmeijen appealed the decision, and it went before Chief Judge James F. McKay, III, Judge Edwin A. Lombard, and Judge Rosemary Ledet. They affirmed the judgment against Leidelmeijen.

What happens when a verdict that the employee is entitled to Workers’ Compensation Benefits has been handed down by the Office of Workers’ Compensation, but the awarded medical benefits have not and are not being paid? Generally, an employee will move for penalties and attorney fees to be imposed on the employer or its insurer for failure to pay the benefits. Under Louisiana law, awarded medical benefits must be paid within sixty days of the employer or insurer receiving notice that the employee has been awarded medical benefits. La. R.S. 23:1201. Failure to pay the medical benefits within sixty days requires the imposition of penalties and attorney fees on the employer or insurer unless the employer or insurer reasonably controverts the employee’s claim. Id.

Vanessa Weaver (“Ms. Weaver”) was awarded supplemental earning benefits (“SEB”) after proving that she was injured at work by falling and hitting her wrist on a pipe, and that she was not able to make 90 percent of her pre-injury wage regardless of whether she was in the same or similar occupation that she had prior to her on-the-job injury. See La. R.S. 23:1221. Her employer Louisiana Wholesale Drug Company, Inc. (“LWD”) contended that the Office of Workers’ Compensation erred in awarded Ms. Weaver SEB’s. As a result, LWD failed to pay Ms. Weaver her awarded medical benefits within sixty days of LWD and its insurers being put on notice of the award.

As mentioned above, LWD may get around the requirement to pay penalties and attorneys’ fees for their failure to pay Ms. Weaver her medical benefits within sixty days, if they reasonable controvert her claim. La. R.S. 23:1201. Meaning, LWD must present sufficient factual and medical information to reasonably counter the evidence provided by Ms. Weaver. Mouton v. Walgreen Co., (La. App. Cir. 2008). LWD was able to controvert Ms. Weaver’s claim with the theory that Ms. Weaver was able to continue working at her pre-injury job, making her pre-injury salary.

What happens with Workers’ Compensation Benefits when you are still able to work, but cannot make your pre-injury wage? Are you entitled to the difference in pre-injury and post-injury wages? Or are you out of luck? Supplemental earning benefits (“SEB”) are paid at two-thirds of the difference between what a person earned before their on-the-job injury and after their on the job injury, whether working or not. SEB’s are available to an individual who was injured at work and is unable to earn at least 90 percent of their pre-injury salary due to the injury. La. R.S. 23:1221.

It is uncommon for the employer, Louisiana Wholesale Drug Company, Inc. (“LWD”), in this case, to argue that the employee is not entitled to SEB’s for a multitude of reasons. Here, for example, LWD is arguing that Vanessa Weaver (“Ms. Weaver”), is not entitled to SEB’s because she voluntarily terminated her employment while LWD was accommodating Ms. Weaver’s work restrictions. Ms. Weaver, on the other hand, alleges that she terminated her employment because LWD was no longer accommodating her by requiring her to lift a box, which was against her work restrictions.

While working at LWD, a box of glass bottles began to fall, so Ms. Weaver dove to stop them from shattering, as she dove, she hit her wrist on a pipe. She went to the hospital, which noted swelling, bruising, and soreness. The doctor allowed her to return to work, but ordered restrictions, including that she was not able to use the injured part of her hand (i.e., her wrist). The injury occurred in March of 2013, and in July 2013 when she terminated her employment her wrist was still sore, and there was a palpable “click.” Further, in July 2013 her work restrictions had not been lifted. As a result, when Ms. Weaver terminated her employment, she alleged that she was entitled to SEB’s because she could not make her pre-injury salary, as LWD was no longer accommodating her injury.

On the job injuries often present complicated healthcare-related decisions., especially when it comes to pain management. What happens when an insurer denies a successful treatment option? In the case of one Caddo Parish employee, securing effective pain management became an equally difficult encounter.  

After suffering a work-related injury, Ms. Veronica Black began experiencing chronic pain in her hands. Ms. Black sought treatment from both an orthopedic surgeon, and a pain management specialist. She was diagnosed with two disorders, chronic regional pain syndrome (CRPS) and carpal tunnel syndrome (CTS), and prescribed a powerful topical cream. Thankfully, the prescribed cream alleviated some of Ms. Black’s pain.

In spite of this solution, CenturyLink’s insurer denied the approval request that Ms. Black’s doctor filed, stating the topical cream could not be considered a medical necessity. Ms. Black filed a claim in response to the Medical Director for the Office of Workers’ Compensation Administration, disputing the insurer’s determination. On February 11, 2015, the Medical Director denied her request, citing a lack of research supporting the topical cream’s use in effective pain management. Ms. Black also filed compensation claims against CenturyLink, and its insurer, Sedgwick, soon after. These claims were similarly unsuccessful.

Worker’s compensation protects workers from unexpected accidents by providing for their medical care and lost wages if ever they suffer an incapacitating accident. And in most instances, a worker’s compensation claim will cover any subsequent accidents which arise from the work-related injury. But when the link between a new accident and the original work-related one is too far removed, an injured worker may have difficulty advancing his claim. For example, can you file a workers compensation claim for an at-home accident?

On July 21, 2014, Raymond Namias was alone when he suffered an injury on the job. The engine upon which he was working slid backward, smashing his right hand. Namias claimed the accident caused additional damage to his right wrist, shoulder, and back. About a month later, on August 31, Namias fell down his stairs in his home. Namias claimed the two accidents were connected, asserting back pain from the job site injury caused numbness in his leg, and that the numbness caused the fall. He filed a worker’s compensation claim for the injuries sustained in both incidents.

Namias’ employer, Sunbelt Innovative Plastics (“Sunbelt”), disputed the extent of his injuries. Additionally, Sunbelt disputed the fact that Namias’ work-related injuries caused his August 31 fall at home. Sunbelt asserted that Namias was not entitled to workers’ compensation for either incident. The matter went to trial before a Worker’s Compensation Judge (“WCJ”).

No 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.