Barron v. First Lake Properties, Inc.

636 So. 2d 970, 1994 La. App. LEXIS 858, 1994 WL 99199
CourtLouisiana Court of Appeal
DecidedMarch 29, 1994
Docket93-CA-902
StatusPublished
Cited by13 cases

This text of 636 So. 2d 970 (Barron v. First Lake Properties, Inc.) 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
Barron v. First Lake Properties, Inc., 636 So. 2d 970, 1994 La. App. LEXIS 858, 1994 WL 99199 (La. Ct. App. 1994).

Opinion

636 So.2d 970 (1994)

Barbara BARRON
v.
FIRST LAKE PROPERTIES, INC.

No. 93-CA-902.

Court of Appeal of Louisiana, Fifth Circuit.

March 29, 1994.

Peter A. Kopfinger, Philip G. Caire, Blondeau, Caire & Gregorie, Baton Rouge, for defendant-appellant, First Lake Properties, Inc.

Harry E. Forst, New Orleans, for plaintiff-appellee, Barbara Barron.

Rodney J. Lacoste, Jr., Stassi & Griffith, Metairie, for intervenor, appellee-appellant, Jefferson Parish Hosp. Service Dist. No. 2 d/b/a East Jefferson Gen. Hosp.

Before KLIEBERT, BOWES and GRISBAUM, JJ.

BOWES, Judge.

This appeal is taken from a judgment of the Office of Worker's Compensation for the State of Louisiana in favor of plaintiff, Barbara Barron, and intervenor, East Jefferson General Hospital (hereinafter "East Jefferson"). We affirm.

FACTS

Barbara Barron was employed as assistant manager by the defendant, First Lake Properties (hereinafter "First Lake") in July, 1991, when she slipped down several steps and injured herself. She immediately reported the fall, which was unwitnessed, to Susan Spears, the manager; however, no accident or claim forms were filled out or submitted by Spears. Mrs. Barron did not seek treatment for her injuries, which included headaches and back pain, until September of 1991. Meanwhile, on August 30, 1991, plaintiff was laid off her employment at First Lake.

By mid-September, plaintiff's complaints had increased to such an extent that she finally sought medical treatment. She initially saw Dr. Harold Ehrenberg, a chiropractor, on September 17, who referred her to Dr. Michael Wilensky, a neurologist; he ordered diagnostic testing at St. Jude Medical Center and ultimately referred her to Dr. Lucien Miranne of Neurological Associates. Conservative treatment had been unsuccessful and Ms. Barron's continued pain necessitated two more diagnostic tests to be performed at East Jefferson. From those tests, it was discovered that plaintiff suffered from a ruptured cervical disc, and a laminectomy was performed by Dr. Miranne at East Jefferson *971 on October 17, 1991. Sometime after surgery, the compensation insurer, Guarantee Mutual, approved the compensation claim and paid some of the medical bills incurred. After Guarantee refused to pay the remainder of the medical bills, plaintiff filed an action in the Office of Worker's Compensation. Following a hearing, the hearing officer granted judgment in favor of plaintiff in the amount of $5,040.00, plus interest and costs, which sum represents expenses due to Parish Anesthesia (related to surgery) for $770.00; $125.00 to St. Jude Medical Center (initial diagnostic testing); and to Neurological Associates (Dr. Miranne, related to surgery) for $4,145.00. Judgment was also granted in favor of East Jefferson for $7,269.53, plus interest and costs. Attorney fees were disallowed.

ASSIGNMENTS OF ERROR

Defendant/appellant, First Lake, avers on appeal that once Guarantee Mutual paid the $750.00 on each bill as required under LSA-R.S. 23:1142 (infra), that it was error for the trial judge to determine that the insurer had denied compensability of the claim and, further, that he incorrectly interpreted the above statute. East Jefferson answered the appeal averring that the court erred in denying attorney fees.

EVIDENCE AND TESTIMONY

Mrs. Barron testified that in September, when she began medical treatment, she contacted First Lake, through Joy Shane, the personnel director, and also through Ms. Spears. Ms. Shane told plaintiff to forward the bills, and that she would check on the matter as no accident report had been filed.

Once plaintiff was told by her physician that she would need the initial diagnostic testing, she, herself, contacted the insurer's adjusting firm through Don Long, the claims manager who, having not yet received any claim information from First Lake, would not authorize the testing. Plaintiff contacted Ms. Shane again and was again told to send in the medical bills. After she was told she needed surgery, plaintiff again contacted the insurance company and spoke to Ms. Judy Casenza, who had been assigned to the case by Mr. Long on October 3. After informing Ms. Casenza of her situation, plaintiff was told that the adjuster could not deal with her, but that she must obtain an attorney. Plaintiff did not try to contact the employer or the insurer again.

Ms. Diana Hickman, a medical secretary at Neurological Associates, testified that she telephoned the insurance company for approval of the diagnostic testing (to be done at East Jefferson) and was told by an employee named Lisa Mink that this was not a confirmed worker's compensation case; the office was not told to check back in case future medical services were needed, nor that a second opinion would be necessary. Rather, Ms. Hickman was told to contact Barron's private insurance. In Hickman's opinion, the compensation claim had thus been denied. Later, when the necessity for surgery became clear, Ms. Hickman did not contact the insurer again since the claim had already, in her opinion, been denied. Ms. Hickman relayed to East Jefferson the insurance information which she had obtained.

With regard to East Jefferson, Mr. Lou Barovechio, the supervisor of collections and cashiers, testified that as part of the admission process, the admitting physician relays to the hospital all insurance information relative to the patient. East Jefferson had been told by Neurological Associates that the compensation claim had been denied and that the applicable insurance would be the patient's private health plan. East Jefferson did not attempt to contact the insurance carrier for approval for the surgery. Further, it was stipulated at trial that East Jefferson had earlier contacted Guarantee Mutual, on October 4, 1991, to obtain approval of the diagnostic testing ordered by Dr. Miranne, and had been advised that the claim was being investigated and the tests could not be approved at that time. Therefore, according to Mr. Barovechio, the claim was considered denied and there was no further point in pursuing the compensation carrier.

Ms. Judy Casenza, the adjuster, testified that the file on Ms. Barron was received in her office on September 30, and was given to her on October 3. On October 4, East Jefferson contacted her for approval of the diagnostic *972 tests. Ms. Casenza replied that she could not approve the tests, and that the claim was under investigation. In answer to counsel's question "Were you not denying her benefits at that time?" Mrs. Casenza replied "I may have been denying benefits at that time, but I wasn't denying the claim completely, just allowing us to do our investigation." She later stated she was denying benefits "at that point in time." Because the investigation was incomplete, Ms. Casenza agreed that she would not have authorized any diagnostic tests or surgery until October 30, 1991. Ms. Casenza felt that the investigation was warranted because plaintiff's injury occurred in July of 1991, after which she continued to work until she was laid off in August; she did not seek medical treatment until September, and no accident form was submitted until the end of September, over two months later.

ANALYSIS

The applicable law with reference to the claims of this appeal is LSA-R.S. 23:1142 which states, in pertinent part:

B. Nonemergency care. Except as provided herein, each health care provider may not incur more than a total of seven hundred fifty dollars in nonemergency diagnostic testing or treatment without the mutual consent of the payor and the employee.

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Bluebook (online)
636 So. 2d 970, 1994 La. App. LEXIS 858, 1994 WL 99199, Counsel Stack Legal Research, https://law.counselstack.com/opinion/barron-v-first-lake-properties-inc-lactapp-1994.