Banes v. American Mut. Liability Ins. Co.

544 So. 2d 700, 1989 La. App. LEXIS 1056, 1989 WL 54924
CourtLouisiana Court of Appeal
DecidedMay 24, 1989
Docket88-227
StatusPublished
Cited by3 cases

This text of 544 So. 2d 700 (Banes v. American Mut. Liability Ins. Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Banes v. American Mut. Liability Ins. Co., 544 So. 2d 700, 1989 La. App. LEXIS 1056, 1989 WL 54924 (La. Ct. App. 1989).

Opinion

544 So.2d 700 (1989)

Daniel R. BANES, Plaintiff-Appellant,
v.
AMERICAN MUTUAL LIABILITY INS. CO. and Johnson-Massman, Defendants-Appellees.

No. 88-227.

Court of Appeal of Louisiana, Third Circuit.

May 24, 1989.

Fuhrer, Flournoy, Hunter & Morton, John E. Morton, Alexandria, for plaintiff-appellant.

Stafford, Stewart & Potter, Bradley Gadel, Alexandria, for defendants-appellees.

Before GUIDRY, DOUCET and LABORDE, JJ.

LABORDE, Judge.

Plaintiff, Daniel Banes, brought suit against his employer, Johnson-Massman, (Johnson), and its insurer, American Mutual Liability Insurance Company (American), for the alleged wrongful reduction of plaintiff's *701 weekly benefits. Plaintiff filed his original petition on September 29, 1987, alleging a cause of action for worker's compensation benefits and a cause of action for intentional tort and/or unfair or deceptive trade practices. Defendants filed exceptions of prematurity, improper cumulation of actions, venue and vagueness. On December 7, 1987, the trial court held a hearing on these exceptions, after which the matter was taken under advisement. While the exceptions were being decided, plaintiff amended his petition to reform his second cause of action, adding a claim under the abuse of rights doctrine. On January 12, 1988, the district court rendered its ruling on the exceptions, finding that the plaintiff's first cause of action was premature and that venue for plaintiff's second cause of action was improper. It dismissed plaintiff's lawsuit against Johnson and American without prejudice at plaintiff's cost. Plaintiff appealed this determination. On May 31, 1988, defendants filed an exception of no cause of action with this court as to plaintiff's second cause of action. We reverse the district court's ruling on the exception of prematurity concerning plaintiff's first cause of action and remand the case to the district court for a trial on the merits. However, we also find that plaintiff's second cause of action is barred by the workmen's compensation exclusive remedy provision. Thus, we dismiss this portion of plaintiff's suit on the ground that it fails to state a cause of action against the defendants.

FACTS

On January 4, 1984, plaintiff sustained an injury during the course and scope of his employment with Johnson.[1] Plaintiff was subsequently provided with compensation benefits and medical treatment by American. In 1986, American apparently offered rehabilitation services to the plaintiff so that he could be retrained for some other type of employment. When plaintiff did not voluntarily accept rehabilitation services, defendants filed an application with the Office of Worker's Compensation (Office) to have plaintiff evaluated for rehabilitation purposes pursuant to LSA-R.S. 23:1226(C).[2] The Office issued a recommendation that plaintiff undergo rehabilitation services. When plaintiff still did not submit himself for rehabilitation evaluation, defendants reduced his weekly worker's compensation benefits by fifty (50%) percent pursuant to LSA-R.S. 23:1226(E).[3]

EXCEPTION OF PREMATURITY

APPLICABLE STATUTES

The following provisions of the Louisiana worker's compensation law, in effect at the time of the suit, are central to the prematurity issue.

"LSA-R.S. 23:1310:

A. If, at any time after notification to the office of the occurrence of death or injury resulting in excess of seven days lost time, a bona fide dispute occurs, the employee or his dependent or the employer or insurer may file a claim with the office on a form to be provided by the director.
B. In addition to any other information required by the director, the claim shall set forth the time, place, nature, and cause of the injury, the benefit in *702 dispute, and the employee's actual earnings, if any, at the time of the filing of the claim with the office.

LSA-R.S. 23:1310.1 provides in relevant part:

A. Upon receipt, every claim for benefits filed under this Chapter shall be evaluated by the office. Within thirty days after the receipt of the claim, the office shall issue its recommendation for resolution and provide the parties with a copy of the recommendation by certified mail, return receipt requested. Such recommendation shall be advisory only and may be admissible into evidence in any subsequent legal proceeding; however, the recommendation when admitted into evidence shall not be accorded any presumption of correctness as to the facts or the law. Within thirty days of receipt of the recommendation of the office, each party shall notify the office on a form to be provided by the director of the acceptance or rejection of the recommendation. A party failing to so notify the office shall be conclusively presumed to have accepted the recommendation of the office. Should any party notify the office that it rejects the recommendation, the office shall issue to each party a certificate that the claim was submitted to the office, that the parties attempted to informally resolve the claim, but that the office's recommendation was rejected. Such certificate shall not set forth either the recommendation of the office or the name of the rejecting party or parties.

LSA-R.S. 23:1314:

A. The presentation and filing of the petition under R.S. 23:1311 shall be premature unless it is alleged in the petition that the claim for compensation has been submitted to the office for informal resolution and that such attempt to informally resolve the claim has failed and:
(1) The employee or dependent is not being or has not been paid, and the employer has refused to pay, the maximum percentage of wages to which petitioner is entitled under this Chapter; or
(2) The employee has not been furnished the proper medical attention; or
(3) The employee has not been furnished copies of the reports of examination made by the employer's medical practitioners after written request therefor has been made under this Chapter.
B. The petition shall be dismissed when the allegations in Subsection (A) of this Section are denied by the employer and are shown at a time fixed by the court to be without reasonable cause or foundation in fact or the petition is not accompanied by a copy of the certificate of the office as required by R.S. 23:1310.1.
C. The court shall determine whether the petition is premature and must be dismissed before proceeding with the hearing of the other issues involved with the claim.[4]

LSA-R.S. 23:1331(C) reads as follows:

C. At any time after six months after rendition of a judgment of compensation by the district court or at any time after six months from the date of the acceptance by the parties of the recommendation of the director under R.S. 23:1310.1, the director shall review the same upon the application of either party for a modification thereof and shall issue a recommendation pursuant to R.S. 23:1310.1."

Plaintiff contends that the district court improperly dismissed his first cause of action on an exception of prematurity. He asserts that the Office failed to comply with its statutory duty to issue a new recommendation upon his request for a redetermination of the advisability of rehabilitation services under the Act. Thus, plaintiff claims that he is prejudiced by the Office's refusal to issue another recommendation and that he should be allowed to maintain his claim in the district court. We agree.

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Cite This Page — Counsel Stack

Bluebook (online)
544 So. 2d 700, 1989 La. App. LEXIS 1056, 1989 WL 54924, Counsel Stack Legal Research, https://law.counselstack.com/opinion/banes-v-american-mut-liability-ins-co-lactapp-1989.