Bailey v. Smelser Oil & Gas, Inc.

620 So. 2d 277, 1993 WL 240002
Supreme Court of Louisiana·Decided July 26, 1993·No. 93-C-0028·Published·Cited by 78 cases

Opinion

620 So.2d 277 (1993)

Frank BAILEY
v.
SMELSER OIL & GAS, INC., et al.

No. 93-C-0028.

Supreme Court of Louisiana.

July 1, 1993.
Rehearing Not Considered July 26, 1993.

Robert M. Hanna, Shreveport, for applicant.

James E. Patton, II, Ramsey L. Ogg, Davenport, Files & Kelly, Monroe, for respondent.

HALL, Justice.[*]

In this worker's compensation case, we initially granted certiorari to determine if the court of appeal had properly applied the correct standard of review to the hearing officer's factual findings. After careful review of the record, we conclude, however, that the primary issues in this case are (1) whether plaintiff is entitled to medical services to be paid by defendants, and (2) whether defendants' refusal to pay for such services resulted in plaintiff's inability to prove disability under LSA-23:1221. The trial court found plaintiff was disabled and entitled to benefits and medical services. The court of appeal reversed. We set aside both judgments and remand the case to the hearing officer for entry of appropriate orders requiring defendants to pay for a complete neurological and orthopedic exam and any necessary treatment, and thereafter for a hearing and determination of disability and entitlement to penalties and attorney's fees.

*278 I.

Frank Bailey was injured in an accident involving an 18-wheeler gasoline truck he was driving on February 7, 1990, while in the course and scope of his employment with Smelser Oil & Gas, Inc. The employer's worker's compensation insurer, Highlands Insurance Company, not disputing that the plaintiff had suffered a compensable injury, paid worker's compensation benefits in the amount of $276.00 per week commencing February 17, 1990.

Following the accident, plaintiff was referred by defendants to Dr. Clyde Elliot complaining of headaches, neck and back pain. The doctor's initial diagnosis was muscle spasms and whiplash, severe enough for admittance to Glenwood Regional Medical Center in West Monroe. Dr. Elliot found it necessary to refer plaintiff to Dr. Myron Bailey, Jr., an orthopedist. Dr. Bailey's initial visit with plaintiff occurred on February 10, 1990, while plaintiff was still hospitalized. Dr. Bailey ordered MRI's, and on February 16, after negative MRI results and treatment for his injuries, plaintiff was discharged from the hospital. At the time of discharge, Dr. Bailey noted that he expected the plaintiff to be able to return to work in about three months.

After discharge from the hospital, plaintiff saw Dr. Bailey in his office on four separate occasions still complaining of headaches, neck pain and back pain. During these visits, Dr. Bailey began to think that plaintiff was exaggerating his condition and recommended that he have a psychological consultation. Plaintiff did not keep appointments made for him with a psychologist. The last visit to Dr. Bailey occurred on May 31, 1990, at which time Dr. Bailey concluded that the origin of the symptoms seemed to be "supratentorial," apparently meaning psychological or exaggerated. In a letter dated July 26, 1990, to the employer's worker's compensation insurer and later in a verified report that was introduced into evidence at trial, Dr. Bailey concluded that if he had to give an opinion regarding disability, plaintiff was capable of returning to work given there were minimal objective findings to explain his subjective complaints. Based upon the letter, defendants suspended worker's compensation benefits as of August 3, 1990.

During treatment, Dr. Bailey found that a neurological exam was indicated and he attempted to find a neurologist in Shreveport or Monroe that would accept plaintiff, but was unable to locate a doctor that would take a worker's compensation patient. Therefore, as he explained to defendants in the same July 26 letter that concluded plaintiff could return to work, he had referred plaintiff to Dr. Ingram, a Jackson, Mississippi neurologist. He noted that referral to out-of-state doctors had been necessary in the past in worker's compensation cases. Plaintiff lives in Delhi, Louisiana and the distance from his home to Jackson was shorter than the distance from his home to Shreveport. On May 29, 1991, Dr. Ingram examined plaintiff and concluded that he suffered from post-traumatic headaches and recommended tricyclic antidepressants. The doctor wanted to see plaintiff in four weeks for a follow-up. Relying on LSA-R.S. 23:1203(A)[1], defendants refused to pay for Dr. Ingram's services solely because he was an out-of-state physician, and because of defendants' failure to pay, plaintiff did not return for the recommended treatment.

Discouraged about the inability of any of his current doctors to relieve his pain, *279 plaintiff went to see Dr. Daniel Dare, an orthopedist in Vicksburg, Mississippi, which is closer to plaintiff's home than Monroe. Dr. Dare examined plaintiff on August 3, 1990. His exam revealed that plaintiff only had 70% of expected normal range of motion in his cervical spine and some tenderness and tingling in his back. He diagnosed severe cervical lumbar strain and recommended repeat MRI's, electrical studies and a return visit in two weeks. Dr. Dare did not treat plaintiff, as defendants again refused to pay for his services since he was an out-of-state physician. Dr. Dare made no finding with regard to disability.

In October 1990, plaintiff filed a Disputed Claim For Compensation with the Office of Worker's Compensation Administration listing his dispute as "[e]mployee has continuing disability but company says he has fully recovered." After this claim was filed, defendants agreed to pay for plaintiff to have a neurological exam and treatment in Louisiana. The plaintiff saw Dr. Juanita McBeath, a Shreveport physician who specializes in head and neck pain. Dr. McBeath only interviewed plaintiff and did not examine or treat him. Based on this interview, she diagnosed plaintiff as suffering from post-concussion syndrome with post-traumatic headaches. Her recommended treatment consisted of a short hospitalization in Shreveport during which time she was confident she could treat the headaches and further alleviate any other pain. She also wanted to repeat the initial MRI's and x-rays. The record indicates that even though defendants agreed to the visit, they wrote to Dr. McBeath questioning her recommendation for the hospital stay and repetition of the diagnostic tests. Plaintiff never received the recommended treatment from Dr. McBeath.

The hearing officer initially entered an order in April 1991 after a status conference allowing plaintiff to be treated by Dr. McBeath at defendants' cost, including tests that she believed needed to be performed. The order also included a resumption of compensation payments. This order was eventually vacated in June 1991 by the hearing officer as a result of defendants' complaints that such an order could not be entered without a hearing or trial.

A trial was held on September 5, 1991, at which time the hearing officer entered a judgment in favor of plaintiff finding that he was still disabled and ordered compensation benefits be reinstated retroactive to August 3, 1990. The defendants were also ordered to pay all medical expenses, even those that were incurred outside the state. Finally, the hearing officer found defendants were arbitrary and capricious in denying payment and awarded attorney's fees.

On defendants' suspensive appeal, the court of appeal reversed, 609 So.2d 1059 (La.App.

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Bailey v. Smelser Oil & Gas, Inc., 620 So. 2d 277, 1993 WL 240002 (La. 1993).

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