Burmaster Tractor & Truck Service v. Degeorge

742 So. 2d 974, 99 La.App. 5 Cir. 28, 1999 La. App. LEXIS 2401, 1999 WL 674536
CourtLouisiana Court of Appeal
DecidedAugust 31, 1999
DocketNos. 99-CA-28, 99-CA-29
StatusPublished
Cited by2 cases

This text of 742 So. 2d 974 (Burmaster Tractor & Truck Service v. Degeorge) 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
Burmaster Tractor & Truck Service v. Degeorge, 742 So. 2d 974, 99 La.App. 5 Cir. 28, 1999 La. App. LEXIS 2401, 1999 WL 674536 (La. Ct. App. 1999).

Opinion

| .EDWARDS, Judge.

Claimant Armond Degeorge was injured in the course and scope of his employment with Burmaster Tractor and Truck Service (“Burmaster”) on August 2, 1991, when the truck he was driving was struck by another vehicle. The employer had worker’s compensation insurance coverage with Insurance Company of North America (“INA”). Weekly indemnity payments were made to Mr. Degeorge, along with medical benefits.

In 1997, INA filed a proceeding with the Office of Worker’s Compensation, alleging that Mr. Degeorge refused to undergo a functional capacity evaluation (FCE) as recommended by two orthopedic specialists who had examined him. In turn, Mr. Degeorge filed a claim requesting payment of treatment by his choice of physician and requesting modification of a judgment [¡¡awarding an offset under La. R.S. 23:1225. He further alleged continuing disability.

The matters were consolidated for trial.

At trial, Mr. Degeorge testified that following the accident he was treated by Dr. Aiken for his back until 1993, when the doctor retired. Later, the insurance company sent him to Dr. Labadie, who hurt him during the examination. He told his attorney that he could hardly move without his medication, and this was told to the insurance company which wanted him to undergo an FCE.

After telling his counsel that he couldn’t find another physician to treat his back, he was referred to Dr. Rawls, a family practitioner and has had to pay that physician as well as pay for his own prescriptions. He received two checks from the insurer, one for $679.36, for services from 12/14/95 to 4/8/97; and one for $1376.00, for services from 6/30/94-4/8/97. No explanations of the services were attached to the checks.

After the court ruled that the insurer was entitled to an offset for Social Security benefits, Mr. Degeorge advised Social Security that his compensation payments had been reduced. However, his federal benefits did not increase. Prior to the offset, he was getting $218.70 per week; it was cut to $55.33, then changed to $110.65. Claimant did not know if Dr. Rawls was sending his bills to the insurer.

Mr. Degeorge was examined by Dr. Bruce Razza, an orthopedist, at the request of his attorney. His deposition was admitted at trial. Dr. Razza testified that an MRI of claimant’s cervical spine revealed a left lateral disc herniation. An MRI and a CAT scan of the lumbar spine demonstrated degenerative narrowing of lumbosacral discs and a herniation at the L5-S1 level. Dr. Razza recommended additional testing with E.M.G.’s for the left arm and right leg. Those tests were normal. Dr. Razza | recommended conservative treatment, including physical therapy, along with the medication claimant was already taking.

Dr. Claude Williams, an orthopedist, examined Mr. Degeorge on behalf of INA. His deposition was also admitted at trial. Dr. Williams found that the claimant sus[976]*976tained both a lumbar and a cervical strain from the accident which were superimposed over existing degenerative changes. Conservative treatment was recommended, along with an FCE. Dr. Williams assigned a 15% whole body disability and opined that the symptoms originated from the accident.

Maryann Doussard, a registered nurse employed by Intercore, a priváte disability management firm, testified that in June of 1994, she arranged an appointment for Mr. Degeorge with neurologist, Dr. Truax. In August of 1994, at the choice and request of INA, claimant was scheduled to see Dr. Laborde, an orthopedist, for a second opinion. Claimant’s counsel refused to permit the examination, and nothing more was done by Ms. Doussard. In January of 1997, she made an appointment for claimant to see Dr. Claude Williams. Dr. Williams was INA’s choice for an independent medical examiner and had not been chosen by the court. At that time, an FCE was set up for April 15, 1997. Mr. Degeorge did not attend the FCE, and the witness did not, attempt to reschedule the examination. Mr. Mitchell from Reliability sent her a letter stating that he had tried to contact claimant’s counsel to reschedule the FCE, and that Mr. Degeorge would not stop taking his medication in order to take the evaluation testing.

I ¡¡Dr. Russell Rawls testified that he first saw claimant in May, 1994, at which time he complained of pain in his back, radiating to his leg and neck and down his left arm. The onset of the problems was the accident in question. At the time, Mr. Degeorge needed a general medical doctor since he had not had surgery. The doctor had a copy of an MRI of the lumbar spine done in June, 1995, another one of the thoracic spine, a CT scan of the cervical spine from May, 1993, an evaluation done by Dr. Bruce Razza, and a report from Dr. Aiken.

Dr. Rawls has given claimant conservative symptomatic treatment. He knew that this was a worker’s compensation claim, but he was not involved in the billing in his office and did not know who paid part of the claimant’s bill. The doctor prescribes analgesics to treat pain and tranquilizers to help handle the stress of the injury. He knows that Mr. Degeorge is reluctant to undergo surgery.

On cross-examination, Dr. Rawls did not know if his office attempted to contact the comp insurer when Mr. Degeorge began treatment. Dr. Rawls stated that he tried claimant on non-steroidal anti-inflammatory medicines. However, given his refusal to have surgery, the only choice he has is medication for pain. While pain management, followed by an FCE could be attempted, the doctor was not sure that these things would help in this particular case.

Numerous exhibits were filed into the record, including the deposition of Angie Villalon, claims adjuster for INA, infra.

At the conclusion of trial, the court found that the treatment by Dr. Rawls was reasonable and necessary, and that Mr. Degeorge is entitled to payment of all medical bills and medication expenses arising from the accident. The Court |fialso ruled that defendant should submit to the FCE in conformity with the orders of Dr. Razza and should undergo the recommended diagnostic studies and physical therapy prescribed by Dr. Razza; that there have been material changes in circumstances warranting modification of the judgment rendered on March 7, 1997, and that the employer/insurer is entitled to the social security offset under La. R.S. 23:1225(A); and that Burmaster and its insurer were not arbitrary and capricious. Burmaster and INA aver on appeal that it was error for the trial court to order payment of Dr. Rawls’ treatment. By this assignment of error, INA contends that under La. R.S. 23:1142(B), the claimant and his physician must obtain pre-approval for treatment or subject themselves to a $750.00 cap on non-emergency care. It is also averred that the treatment by Dr. [977]*977Rawls was neither reasonable nor necessary. According to INA, the issue of Dr. Rawls treatment did not come up until July of 1997, when Ms. Villalon was presented with bills for payment.

With regard to the necessity of pre-approval, R.S. 23:1142(B) states:

B. Nonemergency care. (1) Except as provided herein, each health care provider may not incur more than a total of seven hundred fifty dollars in nonemer-gency diagnostic testing or-treatment without the mutual consent of the payor and the employee as provided by regulation.

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Bluebook (online)
742 So. 2d 974, 99 La.App. 5 Cir. 28, 1999 La. App. LEXIS 2401, 1999 WL 674536, Counsel Stack Legal Research, https://law.counselstack.com/opinion/burmaster-tractor-truck-service-v-degeorge-lactapp-1999.