Burgess v. Sewerage & Water Board of New Orleans

187 So. 3d 49, 2015 La.App. 4 Cir. 0918, 2016 La. App. LEXIS 186, 2016 WL 454064
CourtLouisiana Court of Appeal
DecidedFebruary 3, 2016
DocketNo. 2015-CA-0918
StatusPublished
Cited by7 cases

This text of 187 So. 3d 49 (Burgess v. Sewerage & Water Board of New Orleans) 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
Burgess v. Sewerage & Water Board of New Orleans, 187 So. 3d 49, 2015 La.App. 4 Cir. 0918, 2016 La. App. LEXIS 186, 2016 WL 454064 (La. Ct. App. 2016).

Opinions

ROSEMARY LEDET, Judge.

1 -(Tills is a workers’ compensation case. The sole .issue presented on this appeal is the legal, issue of whether the choice of pharmacy belongs to the employee. Answering that question 'in the affirmative, we affirm the trial court’s judgment ordering the employer to reimburse the employee for prescription medications obtained from the pharmacy selected by the employee.

FACTUAL AND PROCEDURAL BACKGROUND1

On October 13, 2008, Darvel Burgess, an employee of the Sewerage and Water Board of New Orleans (the “S & WB”), sustained neck and back injuries while working as a maintenance technician. He was injured when he fell from the bed of a pick-up truck onto the street. From the date of the injury, the S <⅞ WB paid Mr. Burgess workers’ compensation indemnity benefits — TTD or SEB payments — and certain medical benefits.'

On October 10, 2011, the S & WB sent Mr. Burgess a letter, which was addressed to “All Injured Workers,” that stated:

| ¡>[The] Sewerage and Water board has partnered with Corvel Caremark Pharmacy Program for all Injured Employees. This Pharmacy card will replace any pharmacy program that you may be currently using. It is your responsibility to purchase all medications related to your injury with the attached pharmacy card.- :
Failure- to adhere to this practice may result in non-payment of your Worker’s Compepsation medication.

. On October 18,2011, Mr. Burgess signed a copy of the letter acknowledging he would adhere to the S & WB’s pharmacy program.

On April 12, 2012, the S & WB sent a letter to Injured Workers Pharmacy (“IWP”) — Mr. Burgess’ choice of pharmacy.2 The letter stated that IWP “is not an approved pharmacy provider” for the S & WB’s prescription claims, that IWP should not accept prescriptions from the S & WB’s injured workers, and that any prescription bills submitted by IWP for payment would be denied. On August 22, 2012, the S & WB sent a second letter to IWP, which stated that the S & WB was no longer paying bills submitted from IWP because it had a pharmacy program for its injured workers and that IWP’s request for payment for Mr. Burgess’ prescription medications was denied.

On September 21, 2012, Mr. Burgess filed a disputed claim for compensation against the S & WB alleging a dispute as to both his disability status — TTD or SEB — and certain unpaid medical bills — ■ medical expenses due to Advanced Neuro-diagnostic Center and prescription expenses due to IWP. ' Mr. Burgess also requested an award of attorney’s fees and penalties for S & WB’s failure to timely pay the medical'bills. S & WB subsequently answered the disputed |..¡claim, [51]*51Thereafter, the matter was stayed twice at Mr. Burgess’ request, with no objection from the S & WB.

On April 21, 2015, the- trial court ordered the parties to submit trial briefs on two issues: (i) unpaid prescription bills from IWP, and (ii) unpaid medical bills from Advanced Neurodiagnostic Center. After the briefs were received, the matter was submitted to the trial court on the trial briefs and the attached exhibits.3 On June 18, 2015, the trial court rendered a final judgment in Mr. Burgess’ favor; the trial court ruled as follows:

• The Employer shall pay the outstanding balance for medications supplied' by Injured Workers’ Pharmacy (“IWP”) in ■ the amount of $13,110.82. ■ >
Defendant shall pay any and all outstanding medical expenses owed to Advanced Neurodiagnostic Center via the fee schedule.
The Employer shall pay a $2,000.00 penalty and a $2,000.00 attorney fee due to its failure to timely pay medication and medical expenses in this matter. From this’judgment, the S & WB-appeals.

STANDARD OF REVIEW'

Summarizing the applicable standard of review in workers’ compensation cases, -this court in Augusta v. Audubon Zoo, 15-0300, p. 3 (La.App. 4 Cir. 9/23/15), 176 So.3d 616, 617-18, stated:

In workers’ compensation cases, 'the appropriate standard of review 'to be applied by the appellate court to the OWC’s findings of fact is the manifest error-clearly wrong standard. Dean v. Southmark Constr., 2003-1051, p. 7 (La.7/6/04), 879 So.2d 112, 117. ' When legal error interdicts the fact-finding process in a workers’ compensation proceeding, the de novo, rather than the manifest error, standard of | ¿review applies. MacFarlane v. Schneider Nat’l Bulk Carriers, Inc., 2007-1386, p. 3 (La. App. 4 Cir. 4/30/08), 984 So.2d 185, 188. Likewise, interpretation of statutes pertaining to workers’ compensation, is a question of law and warrants a de novo review to determine if the ruling was •legally correct. Id.

Id.-As noted at the outset, this appeal presents a-legal-issue to which a de novo standard of review applies.

DISCUSSION

An -employer’s obligation to furnish medical expenses is governed by La.’ R.S. 23:1203 A, which provides that “the employer shall furnish all necessary drugs, supplies, hospital care and services, medical and surgical treatment, and any non-medical treatment- recognized by the laws of this state as legal.” The employer’s obligation under this section, however, is limited by La. R.S. 23:1203 B, which provides:-

' The obligation of the employer to furnish such care, services, treatment, drugs, and supplies, whether in state or out of state, is -limited to the reimbursement determined to be the mean of the usual and- customary charges for such care, services, treatment, drugs, - and supplies, -as determined under the reimbursement schedule annually published pursuant to R.S. 23:1034.2 or the actual ■ charge made for the service, whichever • is less.

Under La. R.S. 23:1203 A, the employer is obligated to provide the employee with all necessary prescription medication.

[52]*52This appeal presents the purely legal question of whether the choice of pharmacy at which to procure necessary prescription medications belongs to the employee. It is purely a legal question because the S & WB does not dispute that Mr. Burgess’ prescription medications were reasonably necessary or that the cost of his pres'cription medications was within the reimbursement schedule of fees; rather, the S & "WB disputes only the pharmacy at which the prescription | ¿medications were to be obtained. See Davis Plumbing Co., Inc. v. Burns, 967 So.2d 94, 97 (Ala.Civ.App.2007).

The same legal question, albeit under the Alabama Worker’s Compensation Law, was addressed in Davis, supra. In that case, as here, the employer, Davis Plumbing did not dispute that the employee’s prescription medications were reasonably necessary or that the cost of his prescription medications was within the prevailing rate or maximum schedule of fees; rather, the employer disputed only the pharmacy at which the prescription medications were to be obtained. The Alabama Workers’ Compensation Law, like the Louisiana Workers’ Compensation Law, was silent on the issue of who has the authority in a workers’ compensation case to select the pharmacy to be used by the employee.

In Davis, the court construed a statute similar to La. R.S.

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Related

Darvel Burgess v. Sewerage & Water Board of New Orleans
225 So. 3d 1020 (Supreme Court of Louisiana, 2017)
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204 So. 3d 1014 (Louisiana Court of Appeal, 2016)
Leidelmeijen v. Ferncrest Manor Nursing Home Luba Workers' Comp.
191 So. 3d 38 (Louisiana Court of Appeal, 2016)

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Bluebook (online)
187 So. 3d 49, 2015 La.App. 4 Cir. 0918, 2016 La. App. LEXIS 186, 2016 WL 454064, Counsel Stack Legal Research, https://law.counselstack.com/opinion/burgess-v-sewerage-water-board-of-new-orleans-lactapp-2016.