Articles Posted in Workers Compensation

massage_therapy_spa_health-1024x768An injury on the job is never easy to deal with, especially when it results in a permanent disability affecting your ability to perform your regular job functions. A functional capacity evaluation (FCE) may be conducted at the employer’s expense to identify the parameters the claimant may return to work. However, a recent opinion from the Supreme Court of Louisiana held that a claimant does not have the right to choose a physical therapist to conduct the FCE at the employer’s expense. This may raise concerns for claimants who struggle to get back to work.

In May 2006, Paula Clavier sustained injuries to her neck, shoulder, and back while lifting an object, she believed to be lighter than it was. It is not disputed that this injury occurred on the job within the scope of her employment with Coburn Supply Co. Inc. (Coburn) in Harvey, Louisiana. After significant treatment, Corburn ordered an independent medical examination (IME), wherein their doctor, Dr. W. Stan Foster, opined that Clavier should receive an FCE to determine her work ability as she reached maximum medical improvement and would not require further treatment.

Since Clavier initially refused to attend the FCE, the employer filed a motion to compel the FCE, which was to be with a physician they chose. The Workers’ Compensation Court granted this motion.  Upon completion of the FCE, Ms. Clavier did not agree with the findings. She filed a motion requesting that the FCE be conducted with a physician of her choice to compare with the FCE performed by the employer’s physician. Clavier wanted to use an FCE conducted with her physical therapist and argued that Coburn should be responsible for paying for the same. 

inside_ambulance_ambulance_lighting-1024x576Physically demanding jobs can result in workplace injuries that prevent employees from working and earning a wage. However, it is essential when filing a worker’s compensation claim not only to prove your claim but to do so within the timelines required by the courts. A workplace accident claim filed in Metairie, Louisiana shows the importance of timeliness in workers’ compensation lawsuits and helps answer the question; What is the Deadline to File a Workers’ Compensation Claim in Louisiana?

Tramaine Eugene-Robinson was working as an EMT for East Jefferson General Hospital in late 2014. While transporting a patient on a stretcher, a malfunction occurred, causing her to drop the patient and injure her back and knees. When EJGH did not pay her wage benefits, Ms. Eugene-Robinson sued in 2017, alleging that she had suffered an injury of a “developmental nature,” meaning that the injury developed sometime after the actual accident. Although EJGH acknowledged that the plaintiff had experienced an injury at work, they argued that her claim was untimely under La. R.S. 23:1209(A).

La. R.S. 23:1209(A) sets time limits on worker’s compensation claims. The courts have recognized two different situations that establish the date that an injury turns into a disability: 1) the date the employee must stop working due to the injury or 2) the date that an employee is diagnosed as disabled. Winford v. Conerly Corp.

washing_machine_dryer_laundry-1024x768Many jobs require physical labor, which comes with some risks of injury on the clock, especially for those who install and move equipment. Sometimes you get injured while working, and you think, “maybe I can just work through this.” However, if you attempt to work through an injury and don’t report it immediately to your employer, they may try to avoid paying you workers’ compensation benefits. This happened to James Payton, a veteran and previous employee of NASA. Payton’s case helps answer the question; Can I get Workers’ Compensation Benefits if I Don’t Immediately Report My Injury? 

James Payton began working for Sears in 2013. Before this position, Payton served in the military and worked for NASA for 31 years. He was hired at Sears as an appliance technician, which requires some physical labor. During a shift, Payton was installing a washer/dryer in a residence and injured his back. Payton had never been involved in another accident or had injured his back before his employment with Sears. 

Payton continued working after his injury in the hope it would correct itself. Unfortunately, the injury worsened over the next few days, and Payton found it challenging to complete simple actions, such as getting out of bed or driving a car. After visiting a physician and receiving an MRI, it was confirmed that Payton had herniated discs in his lower back, and he was advised to avoid heavy lifting. He then reported his medical diagnosis to Sears approximately a month after the initial injury.  

tire_repairer_tire_mounting-1024x681Injuring yourself while on the job is not fun for anyone, especially when your accident further exacerbates a previous workplace injury. What happens if you then try to seek retroactive benefits from your previous injury? You may run into an issue of prescription (otherwise known as the statute of limitations). A 2016 case from Terrebonne Parish explores how prescription can play out in a compound workplace injury.

Gerald Hellmers was a mechanic for the Port of New Orleans. On August 23, 2007, Hellmers injured his lower back while changing a tire as part of his duties at work. He required hospitalization and surgery at Tulane University Hospital and Clinic (“Tulane”). Worker’s compensation benefits were paid to Hellmers by the Port. Tulane sent the Port invoices totaling $118,000.00. The Port made some payments but not the total amount owed. 

Hellmers re-injured his lower back while changing a truck battery on January 13, 2009. Again, Hellmers was hospitalized at Tulane, and the Port paid worker’s compensation benefits. Tulane billed for this treatment, but once again, the Port didn’t pay the total bill.

toronto_skyline_early_morning-1024x577A dilatory exception for prematurity is defined in the Louisiana Code of Civil Procedure Article 926(A). There are many reasons why a lawsuit may be premature, or in other words, ripe for a dilatory exception of prematurity. A case may be premature when it is too early in a dispute for the court to have the authority to rule on it. A lawsuit may be premature if there is another administrative body that the case should go to beforehand. The legal issues of prematurity and dilatory exceptions are shown below in a lawsuit from St. Tammany parish.

A Nestle Holdings employee was injured during his employment, and Nestle received a large bill from Lakeview Regional Medical Center (LRMC) for surgery on the employee. Nestle responded by sending back about 10% of the original price, expecting LRMC to initiate an administrative action, which would give Nestle a chance to argue for a lesser price. However, when LRMC did nothing to protest the partial payment, Nestle filed a complaint with the Office of Worker’s Compensation (OWC), a judicial body. OWC rejected the complaint and granted LRMC’s claim of a dilatory exception of prematurity; Nestle appealed the OWC decision to the First Circuit Court of Appeals. 

The First Circuit Court of Appeals upheld the OWC decision to dismiss the complaint due to prematurity. The court first examined Louisiana Code of Civil Procedure Article 926(A)(1), reasoning that it allows for a dilatory exception objection of prematurity to be brought before the litigation commences. The court held that this objection may be used in lawsuits where the law or contract allows for a procedure for the party to seek out administrative relief before resorting to filing a lawsuit. If this exception is raised, the person who raises it bears the initial burden of showing that another remedy or procedure applies, and therefore the lawsuit is premature. For example, this can be done by filing a copy of the contract between the parties into the record, assuming the contract discusses a prelawsuit procedure. After the existence of the alternative remedy is established, the burden then shifts to the other party to show that the specific remedy or procedure has been exhausted.

skeleton_bone_medical_doctor-1024x768Injuries sustained on the job present challenges for the employee and employer, especially when multiple sites of injury are involved. In addition, injuries all over the body can require different medical treatments for each affected area. Specialized treatments such as a spinal cord stimulator can be recommended to alleviate pain to an injured worker. However, a workers compensation insurance company may not be amenable to pay for such treatment. The following case addresses the question, can a workers compensation claimant receive spinal cord stimulator treatment in Louisiana?

Byron Gulley sustained injuries to his head, shoulder, wrist, back, knee, hip, foot and ankle as a result of a golf cart accident while working for the Hope Youth Ranch in June 2009. The claimant was seeing a pain management specialist, Dr. Chad Domangue, who recommended a spinal cord stimulator trial because other medications and treatments failed to address Gulley’s significant low back adequately, left hip, and leg pain. As such, Dr. Domangue filed the proper form requesting this treatment pursuant to the Medical Treatment Guidelines. This request was ultimately denied by the employer’s insurance carrier. Gulley brought the denial to the Medical Director of the Office of Workers’ Compensation, which also rejected the request and the Workers’ Compensation District two affirmed the denial. 

Thereafter, Dr. Domangue continued to see and treat Gulley. Even though the spinal cord stimulator could not address all areas of Gulley’s pain, he believed it was the best option to treat his most significant pain areas. As such, he filed a second request, which was also denied by the employer’s insurance carrier. Gulley then sought approval for the procedure from the Medical Director, who again denied approval because the topography of the claimant’s pain was not amenable to stimulation coverage. 

source_grass_lawn_water-1024x683The Collateral Source Rule in Louisiana law prevents a tortfeasor (a person who harmed another) from benefiting from the victim’s receipt of funds from an independent source.  So what does that mean?

Let’s say you were injured in a car wreck. As a result of your injuries, you have back surgery before the lawsuit settles. If you have health insurance, that surgery may be paid for by your health insurer. However, your health insurance company pays only part of the bill; they pay some agreed-upon amount with the medical provider. The collateral source rule allows the injured person to argue for the amount paid for the surgery plus 40% of the difference of the billed amount. An example is shown below:

  1. Joe is injured in a car wreck, has health insurance, and undergoes a $100,000 back surgery by ABC Back Drs.

workers_construction_worker_work-1024x576It can be a long road to recovery from a work-related injury. If you or a loved one suffered an injury on the job, it is crucial to understand the workers’ compensation system to comply with all the requirements to receive any compensation to which you are entitled. 

Carl Gabriel worked as a “Ready Reserve” employee at Delta. Less than two months after he started working, he was injured when a tow bar fell onto his foot. After a dispute with his employer over indemnity payments, Gabriel filed a Disputed Claim for Compensation, Form 1008, with the Office of Workers’ Compensation (“OWC”). He asserted that Delta failed to pay indemnity benefits and timely pay and authorize medical benefits. There was a trial where Gabriel won, with the court finding that Gabriel was entitled to benefits from Delta. 

Gabriel then filed a second Disputed Claim for Compensation, alleging that Delta had failed to pay the amounts owed to him under the prior judgment. He also sought penalties under La. R.S. 23:1201(F) and (G) for Delta’s failure to pay correctly. He also alleged that he was temporarily totally disabled again because of a worsening of his medical condition. Gabriel went to two physicians in Atlanta, Georgia, to deal with his worsening condition. Delta argued that neither Gabriel nor his physicians ever properly requested approval for the recommended treatment through Form 1010, submitted to Gabriel’s adjuster. Instead, Gabriel sought approval informally via fax. 

sparks_working_industry_metal-1024x711What happens if you are hurt on the job? Not only do you have to deal with the physical effects of your injury, but you also have to navigate when it is safe to return to work. The workers’ compensation system is designed to aid injured workers. It can provide compensation for lost wages and medical treatment. However, it can often be complex to navigate. 

This is the situation Eduardo Sanchez, an ironworker at MEMCO Inc., found himself in after he slipped from a metal beam while working. His safety harness caught him. Once safely on the ground, medical personnel at the worksite examined him, and he was sent home to rest. The next day, Sanchez reported to work and complained of a headache and pain in his back, neck, and testicle. He was sent home. Sanchez’s supervisor at MEMCO sent him to see a doctor. The doctor diagnosed Sanchez with a cervical and lumbar strain and released him to return to work “as tolerated.”

Two days later, Sanchez went to the emergency room complaining of chest, testicular, and lumbar pain. The emergency room doctor diagnosed him with lumbosacral strain, chest wall contusion, and a scrotal contusion. Sanchez returned to the doctor who first examined him. He released Sanchez to return to work on restricted duty “as tolerated.” About ten days later, Sanchez returned to the doctor, who discharged him to return to work “full duty.” 

bandit_playmobil_shield_western-683x1024It’s reasonable to want to feel safe at work, no matter your job. Employers must keep their employees free from unnecessary danger and generally provide a safe working environment. Even given this duty, the law doesn’t always hold them responsible for the actions of criminals. A recent lawsuit out of Lafayette discusses the principles court asses to determine what remedies are available to employees when crime happens.

Melody Smith (Smith), an employee of Circle K, was robbed at gunpoint by Marcus Sam while making a bank deposit for the store. After the incident, Smith filed a lawsuit and was eligible for workers’ compensation benefits. Workers’ Compensation is an exclusive remedy for accidents in the workplace. R.S. 23:1032(A)(1)(a).

Smith later filed an amended and supplemental lawsuit that claimed Circle K committed intentional torts of assault and battery on her because they created an environment for her to be robbed. Smith argued that because Sam overheard her manager telling her to make a bank deposit the robbery was inevitable. Circle K disputed Smith’s claims and filed a motion for summary judgment. 

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