Daigle v. Employers National Insurance Co.

747 So. 2d 696, 94 La.App. 3 Cir. 126, 1999 La. App. LEXIS 3332, 1999 WL 1081175
CourtLouisiana Court of Appeal
DecidedDecember 1, 1999
DocketNo. 94-126
StatusPublished
Cited by2 cases

This text of 747 So. 2d 696 (Daigle v. Employers National Insurance Co.) 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
Daigle v. Employers National Insurance Co., 747 So. 2d 696, 94 La.App. 3 Cir. 126, 1999 La. App. LEXIS 3332, 1999 WL 1081175 (La. Ct. App. 1999).

Opinions

JjPICKETT, Judge.

The Defendant was voluntarily paying workers’ compensation benefits to Plaintiff. The Plaintiff was concurrently receiving social security disability benefits for his injury. Defendant offset its payments and filed a notice with the Office of Workers’ Compensation when it learned Plaintiff was also receiving social security benefits. The trial court ruled Defendant was justified under La.R.S. 23:1225 in unilaterally taking the offset since it voluntarily instituted payment of compensation benefits to Plaintiff. The Plaintiff now appeals. [698]*698For the following reasons, we affirm in part and reverse in part.

^BACKGROUND

Plaintiff suffered a workplace injury on February 22, 1983. The employer/insurer voluntarily paid the maximum weekly benefits payable at the time of Plaintiffs accident. The benefits owed Plaintiff were never judicially fixed. Since 1987, Plaintiff has been receiving social security disability benefits for his injury.

In October, 1991, the employer/insurer learned Plaintiff has been receiving social security benefits. On October 28, 1991, the employer/insurer filed a modification notice with the Office of Workers’ Compensation, using an Office of Workers’ Compensation form designed for such purposes, indicating the employer was taking the reverse social security offset.

ASSIGNMENT OF ERRORS

(1) The trial court erred in relying on law and procedure that became effective on or after July 1, 1983, for a claim that arose from an accident which occurred pri- or to July 1,1983.

(2) The trial court erred in ruling the Defendants were entitled to unilaterally take the reverse offset without a judicial determination of the amount of the reverse offset, where there had been no prior determination that Plaintiff was permanently and totally disabled.

(3)/(4) The trial court erred in failing to award compensation benefits with a credit for Defendants’ offset, as well as, penalties and attorney fees to Plaintiff.

OPINION

Plaintiff argues that the trial court erred in relying on La.R.S. 23:1225 which was amended effective July 1, 1983, since Plaintiffs claim arose from an accident which occurred prior to July 1, 1983, and that the reverse offset was unjustified ^without a prior judicial determination of the reverse offset and a determination that Plaintiff was totally disabled.

Considering the recent Louisiana Supreme Court case Al Johnson Construction Company and LIGA v. Donald Pitre, 98-2564 (La.5/18/99); 734 So.2d 623, there is no question that La.R.S. 23:1225(C)(1)(c) does not apply regardless of the date of the injury.

Plaintiff argues La.R.S. 23:1225(A) does not apply because there was no determination at the time of the offset that the Plaintiff was permanently and totally disabled. Although Garrett v. Seventh Ward General Hosp., 95-0017 (La.9/22/95), 660 So.2d 841; was overruled by the Pitre case, our analysis refers to the Garrett discussion of La.R.S. 23:1225(A) which was not at issue in Pitre. In Garrett, the Supreme Court qualified its discussion of La.R.S. 23:1225(A) stating: “plaintiff presently is neither entitled to nor receiving permanent total workers’ compensation benefits ... ”. Id. at 845 (emphasis added).

The issue in this case is whether subsection 1225(A) applies when there was no prior determination that Plaintiff was permanently and totally disabled and both parties have subsequently stipulated Plaintiff is permanently and totally disabled. The Court in Garrett suggests that an offset is applicable if Plaintiff is presently entitled to permanent total disability benefits. Therefore, we affirm in part and find that the employer was authorized to seek a reverse offset under La.R.S. 23:1225(A).

Plaintiff argues that even if La. R.S. 23:1225 is applicable, the Defendant was unjustified in taking a unilateral offset without a prior judicial determination. The workers’ compensation benefits being received by the Plaintiff were never judicially fixed. Rather, since Plaintiffs injury, Defendant has made voluntary payments. Additionally, before taking the offset, Defendant first notified the Office of Workers’ | Compensation. Under such circumstances, case law has consistently [699]*699held that a Defendant has the liberty to unilaterally claim the offset by La.R.S. 23:1225. See Spinks v. James Hutchins Farms, 98-811 (La.App. 3 Cir. 2/3/99); 736 So.2d 226, writ denied, 99-0630 (La.4/23/99); 742 So.2d 888; Clark v. Town of Basile, 98-439 (La.App. 3 Cir. 10/7/98); 719 So.2d 730; McCoy v. Cracker Barrel Stores, Inc., 98-1182 (La.App. 3 Cir. 2/3/99); 736 So.2d 886; writ granted and remanded on other grounds, 99-0641 (La.9/3/99); 747 So.2d 526; Bellard v. South Louisiana Contractors, Inc., 563 So.2d 1319 (La.App. 3 Cir.1990). “If plaintiff disputes defendant’s right to this offset, plaintiff must first submit the dispute to the OWC [Office of Workers’ Compensation] to obtain its recommendation.” McCoy, 736 So.2d at 889 quoting Hebert v. CIGNA, 93-1400, p. 10 (La.App. 3 Cir. 5/25/94); 637 So.2d 1221, 1228 (alteration in original).

The court must insure that a disabled employee is not forced to endure a period of time when he is not receiving his due portion of benefits simply because the Social Security Administration and the employer or his insurer failed to properly coordinate the termination and activation of their respective offsets.

Id.

In the present case the employer’s offset was not coordinated with benefits due from the Social Security Administration. The Plaintiff argues that after Defendants began taking its offset, the Social Security Administration refused to remove its offset and refused to increase Plaintiffs social security disability insurance benefit because the Social Security Administration regulations require a court judgment in workers’ compensation proceedings before the Social Security Administration would remove its offset. Plaintiff claims he suffered a double offset since November 1, 1991. Plaintiff filed a dispute with the Office of Workers’ Compensation which was dismissed because the OWC did not have proper subject matter jurisdiction. Plaintiff | Bbrought the action which is now on appeal.

We find that the Plaintiff has endured a period of time when he has not received his due portion of benefits simply because the Social Security Administration and the employer or his insurer failed to properly coordinate the termination and activation of the respective offsets.

In a situation such as this, where the employer has voluntarily paid benefits without a judicial determination, it is the employer’s responsibility to coordinate any offset taken with the Social Security Administration before taking a unilateral offset.

In the case where a Defendant makes a judicial demand for the offset, Defendant is credited beginning with the time the Defendant made demand for the reverse offset. Guillory v. Stone & Webster Engineering Corp., 545 So.2d 605 (La. App. 3 Cir.1989).

In the present case, the Defendant made no judicial demand. We find the employer is liable for the due portion of benefits Plaintiff would have received had employer properly coordinated the offset with the Social Security Administration.

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747 So. 2d 696, 94 La.App. 3 Cir. 126, 1999 La. App. LEXIS 3332, 1999 WL 1081175, Counsel Stack Legal Research, https://law.counselstack.com/opinion/daigle-v-employers-national-insurance-co-lactapp-1999.