Broussard v. Asco Venture Holdings

229 So. 3d 80, 2017 WL 4401665
CourtLouisiana Court of Appeal
DecidedOctober 4, 2017
DocketWCA 17-90, WCA 17-91
StatusPublished

This text of 229 So. 3d 80 (Broussard v. Asco Venture Holdings) 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
Broussard v. Asco Venture Holdings, 229 So. 3d 80, 2017 WL 4401665 (La. Ct. App. 2017).

Opinion

EZELL, Judge.

■ hAsco Venture Holdings and its insurer, Liberty Mutual Insurance Company (herein after collectively referred to as “Defendants”), appeal the decision of the workers’ compensation judge below awarding Jeffery Broussard $25,468.18, plus penalties and attorney fees, for Defendants’ failure to fully pay a prior judgment against them. For the following reasons, we affirm the decision of the workers’ compensation judge.

Mr. Broussard was injured while working as a truck driver for ASCO in 2004. The Defendants paid him workers’ compensation benefits from the time of his accident through the present time. In 2007, Mr. Broussard’s orthopedic surgeon recommended he lose weight so that he could safely undergo back surgery for his 2004 injuries.1 After several attempts through various methods over the next few years, four doctors, including two of Defendants’ own second medical opinion physicians, recommended bariatric surgery to facilitate Mr. Broussard losing weight. Despite their own doctors “strongly recommending]” the surgery, Defendants twice failed to approve it, making Mr. Broussard financially responsible for the surgery, which was performed in July of 2009. Mr. Broussard eventually filed a 1008 claim form seeking to force Defendants, to pay the costs of his treatment.

In August of 2009, a workers’ compensation judge ordered Defendants to pay Mr. Broussard for “all medical bills incurred, but not yet paid” stemming from the workplace accident, specifically listing bills incurred that totaled $58,336.91, including the cost of the bariatric surgery. Mr. Broussard was also awarded penalties and attorney fees in the amounts of $8,000.00 and $16,000.00, ^respectively. Defendants did not appeal that judgment. Rather than seeking review or paying the judgment as ordered, Defendants instead directly paid the medical providers listed in the judgment at discounted fee schedule rates, rather than the full amounts ordered.

In December of 2009, Mr. Broussard filed the current 1008 claim form, seeking enforcement of the judgment and penalties and attorney fees for Defendants’ failure to fully pay. After several delays, the workers’ compensation judge ruled that the Defendants underpaid the 2009 judgment by $25,468.18 and that the underpayments were not due to any cause beyond Defendants’ control. The workers’ compensation judge further ordered Defendants to pay penalties and attorney fees of $6,112.36 and $15,000.00, respectively. From that decision, Defendants appeal.

On appeal, Defendants assert six assignments of error. Defendants claim that the workers’ compensation judge erred in: ordering judgment in Mr. Broussard’s favor in the amount of $25,468.18; in failing to apply the workers’ compensation fee schedule to the 2009 judgment; in denying their exception of no right of action; in failing to apply La.R.S. 23:1212; in denying Defendants’ motion to modify the 2009 judgment; and in awarding Mr. Broussard penalties and attorney fees.

Non-payment of Judgment

Defendants’ first two assignments of error claim that the workers’ compensation judge erred in awarding Mr. Broussard $25,468.18, as they assert the workers’ compensation judge should have applied the workers’ compensation fee schedule to Mr. Broussard’s medical bills. Defendants assert that , they have fully | ^complied with the 2009 judgment if the fee schedule is applied. Because those assignments of error overlap, we will address them together.

As noted in Banks v. Industrial Roofing & Sheet Metal Works, Inc., 96-2840, pp. 7-8 (La. 7/1/97), 696 So.2d 551, 556 (alteration in original):

Factual findings in workers’ compensation cases are subject to the manifest error or clearly wrong standard of appellate review. Smith v. Louisiana Dep’t of Corrections, 93-1305, p. 4 (La. 2/28/94), 633 So.2d 129, 132; Freeman v. Poulan/Weed Eater, 93-1530, p. 4-5 (La. 1/14/94), 630 So.2d 733, 737-38. In applying the manifest error-clearly wrong standard, the appellate- court must determine not whether the triér of fact was right or wrong, but whether the factfinder’s conclusion was a reasonable one. Freeman, 93-1530 at p. 5, 630 So.2d at 737-38; Stobart v. State, 617 So.2d 880, 882 (La.1993); Mart v. Hill, 505 So.2d 1120, 1127 (La.1987). Where there are two ■ permissible views- of the evidence, a- factfinder’s choice between them can never be manifestly erroneous or clearly wrong. Stobart, 617 So.2d at 882. Thus, “if the [factfinder’s] findings are reasonable in light of the record reviewed in its entirety, the court of appeal may not reverse, even if convinced that had it been sitting as the trier of fact, it would have weighed the evidence differently.” Sistler v. Liberty Mut. Ins. Co., 558 So.2d 1106, 1112 (La. 1990).

The reasoning for a defendant’s failure to pay a final, nonappealable judgment within thirty days is a finding of fact subject to the manifest error standard of review. Wilzcewski v. Brookshire Grocery Co., 10-1148 (La.App. 3 Cir. 3/16/11), 59 So.3d 530.

Defendants argue that Mr. Brous-sard’s medical expenses should have been reduced to the amount recoverable under the workers’ compensation fee schedule as mandated by La.R.S. 23:1203(B). However, when an employer denies a claim, the employer ;can be required to' pay the actual medical expenses incurred by its employee and cannot avail itself of the fee schedule. Louviere v. Food & Fun, Inc., 06-469 (La. App. 3 Cir. 10/11/06), 941 So.2d 155; Smith v. Roy O. Martin Lumber Co., 03-1441 (La.App. 3 Cir. 4/14/04), 871 So.2d 661, writ denied, 04-1311 (La. 9/24/04), 882 So.2d 1144.

|/This is because claimant is then forced to fund the costs of medical treatment himself and because, if the employer denies the claim from the outset, it has no right to pre-approve any treatment. La. R.S. 23:1142(E); Smith v. Roy O. Martin Lumber Co., supra. Since Defendant has continuously denied its liability, . it is liable for the actual medical expenses incurred by Plaintiff.

Lemons v. Georgia Pac. Corp., 42,950, p.11 (La.App. 2 Cir. 2/13/08), 976 So.2d 307, 314, writ denied, 08-587, 08590 (La. 5/2/08), 979 So.2d 1288, 1289.

As noted above, Defendants continuously denied-Mr. Broussard’s claims for bariatric surgery. He was therefore forced to unilaterally schedule the surgery at his own expense. Because they denied the claim, the prior workers’ compensation judge ruled that, the Defendants could not benefit from the fee schedule. Defendants did not appeal that decision.-

Moreover, we note that the bills that were the subject of the 2009 judgment are not truly at issue in the current litigation, as that decision is not currently before this court. Rather, what is in dispute here is whether Defendants actually complied with that 2009 judgment as ordered. It is clear and uncontested that Defendants failed to tender payment in accordance with the 2009 judgment. Instead, Defendants attempted what can only be described as an “end run” around that judgment by unilaterally paying the medical bills described therein at the reduced fee schedule rates, rather than the higher priced bills incurred by Mr. Broussard and specifically ordered to be paid in the judgment. To reiterate, Defendants paid the fee schedule amounts after being ordered to pay the fall amounts, in direct contravention of that judgment. Their partial payments did not satisfy that judgment.

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229 So. 3d 80, 2017 WL 4401665, Counsel Stack Legal Research, https://law.counselstack.com/opinion/broussard-v-asco-venture-holdings-lactapp-2017.