Capdeville v. WINN-DIXIE STORE NO. 1473

923 So. 2d 900, 2006 La. App. LEXIS 424, 2006 WL 470600
CourtLouisiana Court of Appeal
DecidedMarch 1, 2006
Docket2005-870
StatusPublished
Cited by3 cases

This text of 923 So. 2d 900 (Capdeville v. WINN-DIXIE STORE NO. 1473) 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
Capdeville v. WINN-DIXIE STORE NO. 1473, 923 So. 2d 900, 2006 La. App. LEXIS 424, 2006 WL 470600 (La. Ct. App. 2006).

Opinion

923 So.2d 900 (2006)

Debra CAPDEVILLE
v.
WINN-DIXIE STORE # 1473.

No. 2005-870.

Court of Appeal of Louisiana, Third Circuit.

March 1, 2006.

*901 Michael B. Miller, Miller & Miller, Crowley, LA, for Plaintiff/Appellant, Debra Capdeville.

James M. Taylor, Jacqueline A. Romero, Taylor, Wellons, Politz & Duhe, APLC, New Orleans, LA, for Defendant/Appellee Winn-Dixie Store # 1473.

Court composed of ULYSSES GENE THIBODEAUX, Chief Judge, MARC T. AMY and GLENN B. GREMILLION, Judges.

GREMILLION, Judge.

The plaintiff, Debra Capdeville, appeals the judgment of the workers' compensation judge denying her request for penalties and attorney's fees after determining that the defendant, Winn Dixie Store # 1433, failed to authorize required medical treatment. She further appeals the workers' compensation judge's refusal to allow her counsel to testify as to work performed in conjunction with her request for penalties and attorney's fees for Winn Dixie's failure to pay a mileage request. For the following reasons, we affirm in part, reverse in part, and render judgment.

FACTS

Capdeville injured her head and neck when a ten-pound bag of dough fell and struck her as she walked into a freezer at work. She was initially treated by Dr. John Cobb, an orthopedic surgeon, who eventually referred her to Dr. James Pearce, a dentist specializing in temporo-mandibular disorders. Capdeville filed a disputed claim for compensation seeking workers' compensation benefits, medical treatment, and penalties and attorney's fees when Winn Dixie failed to provide her with workers' compensation indemnity benefits and medical treatment.

On March 26, 2001, an Interim Order was reached in which the parties agreed that Winn Dixie would pay temporary total disability benefits to Capdeville at the rate of $145.34 per week and would provide medical benefits, including all reasonable and necessary treatment by Dr. Pearce and other doctors, and the reimbursement of her prescribed medication. On April 21, 2001, a consent judgment was reached based on the parties' stipulations that Capdeville was injured as a result of a work-related injury. The judgment awarded her temporary total disability benefits of $145.34 per week, based on her average weekly wage of $218, and all reasonable necessary medical treatment, including treatment by Dr. Pearce. It further awarded her $1,601.67 in past due weekly compensation benefits, $4,000 in penalties, *902 and $10,000 in attorney's fees. A second consent judgment was rendered on April 21, 2003, in which Winn Dixie agreed to pay Capdeville $4000 in penalties and $2000 in attorney's fees due to its failure to authorize medical treatment for her by Drs. Bertuccini, Pearce, and Berard.

On October 12, 2004, Capdeville filed a Motion and Order for Penalties and Attorney's Fees based on Winn Dixie's failure to authorize medical treatment recommended by Dr. Pearce. She further alleged that she was not fully reimbursed for her mileage expenses associated with her visits to two doctors. Following a hearing on the motion, the workers' compensation judge gave oral reasons for judgment. She ordered Winn Dixie to authorize Dr. Pearce's treatment and further ordered either it or its third-party administrator, Sedgwick CMS, to inform Dr. Pearce's office of the authorization. However, she denied Capdeville's request for penalties and attorney's fees on this issue finding that the matter was reasonably controverted. She did award her $2000 in penalties and $1000 in attorney's fees due to Winn Dixie's failure to pay the mileage request. Judgment was rendered in this matter on April 14, 2005. This appeal by Capdeville followed.

ISSUES

On appeal, Capdeville argues that the workers' compensation judge erred in denying her request for penalties and attorney's fees due to Winn Dixie's failure to approve Dr. Pearce's recommendations. She further argues that the workers' compensation judge erred in refusing to allow her counsel to testify as to the work performed by him with regard to her mileage request.

MEDICAL TREATMENT

Capdeville first argues that the workers' compensation judge erred in finding that Winn Dixie reasonably controverted her request for authorization of medical treatment by Dr. Pearce.

Capdeville testified that she has seen Dr. Pearce twice and has been seeking follow-up treatment from him since her initial appointments. She stated that she called Dr. Pearce's office every day up until the beginning of 2004, checking on the status of her request from Winn Dixie, but stated that she never received it. She further explained that she called his office rather than going in person because she had gone there previously only to be refused treatment because Dr. Pearce did not yet have Winn Dixie's approval.

Capdeville introduced the depositions of Rena King and Karen Hebert into the record. King, an employee of Sedgwick, is the current adjuster of Capdeville's claim. Hebert is Dr. Pearce's office manager. Attached to these depositions were various letters pertaining to Dr. Pearce's request to Winn Dixie for authorization to continue Capdeville's treatment. The documents were as follows:

1) An August 23, 2000 letter from Debra Rawles, the Sedgwick adjustor handling Capdeville's claim at that time, to Dr. Pearce. The letter acknowledges that Dr. Cobb has referred Capdeville to him and authorizes him to see her for an initial visit only. An approval form from Dr. Pearce to Rawles, dated and signed by Rawles on the same date, authorizes approval for a new patient, limited examination and an orthopantomogram.
2) A September 21, 2000 letter from Dr. Pearce to Dr. Cobb. Dr. Pearce recommends a complete evaluation of Capdeville's masticatory apparatus, as well as diagnostic mounted study models and a physical therapy evaluation. The letter was courtesy copied to Rawles, with an approval form requesting the described treatment.
*903 3) An October 18, 2000 letter from Rawles to Dr. Pearce requesting further information from Dr. Pearce as to whether Capdeville's condition was related to her cervical fusion and/or her work-related accident of 1998.
4) An October 24, 2000 letter from Dr. Pearce responding to Rawles letter, in which he causally related her condition to her work-related accident.
5) A November 20, 2000 approval by Rawles sent to Dr. Pearce approving his recommended treatment of Capdeville, on a form provided by Dr. Pearce.
6) A January 22, 2001 letter from Dr. Pearce to Dr. Cobb. Dr. Pearce recommends that Capdeville undergo diagnostic splint therapy for six to nine months in an attempt to reduce the traumatic effects of bruxing and the dental malocclusions in order to find her a comfortable and stable jaw position and to eliminate her complaints of headaches and jaw pain. A copy of this letter was also sent to Rawles along with an authorization form for the splint therapy.
7) A February 5, 2001 letter from Winn Dixie's attorney to Dr. Pearce. Counsel indicated that Winn Dixie had reviewed the doctor's reports of September 21, 2000 and October 24, 2000. It authorized Dr. Pearce's recommended medical treatment, specifically a complete evaluation of Capdeville's masticatory apparatus and a physical therapy evaluation. Counsel further requested Dr. Pearce to forward any further written requests for authorization of treatment and reports of treatment to Rawles.
8) A March 2, 2001 letter from Dr. Pearce to Rawles. Dr.

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Bluebook (online)
923 So. 2d 900, 2006 La. App. LEXIS 424, 2006 WL 470600, Counsel Stack Legal Research, https://law.counselstack.com/opinion/capdeville-v-winn-dixie-store-no-1473-lactapp-2006.