Davis v. United General Ins. Co.

631 So. 2d 572, 93 La.App. 3 Cir. 738, 1994 La. App. LEXIS 228, 1994 WL 28637
CourtLouisiana Court of Appeal
DecidedFebruary 2, 1994
Docket93-738
StatusPublished
Cited by9 cases

This text of 631 So. 2d 572 (Davis v. United General Ins. 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
Davis v. United General Ins. Co., 631 So. 2d 572, 93 La.App. 3 Cir. 738, 1994 La. App. LEXIS 228, 1994 WL 28637 (La. Ct. App. 1994).

Opinion

631 So.2d 572 (1994)

Thomas E. DAVIS, Plaintiff-Appellee,
v.
UNITED GENERAL INSURANCE CO., et al., Defendants-Appellants.

No. 93-738.

Court of Appeal of Louisiana, Third Circuit.

February 2, 1994.
Rehearing Denied March 11, 1994.

*574 James Ray Morris, Lake Charles, for Thomas E. Davis.

Mesonie Terrence Halley Jr., Lake Charles, for LIGA.

Before GUIDRY and YELVERTON, JJ., and BERTRAND, J. Pro Tem.

GUIDRY, Judge.

This is a worker's compensation case. Defendant, the Louisiana Insurance Guaranty Association (LIGA), appeals the trial court's judgment rendered in favor of plaintiff, Thomas Davis, finding Davis to be temporarily and totally disabled and entitled to benefits therefor from November 8, 1984. LIGA asserts that the trial court erred in denying its peremptory exception of prescription and finding that Davis proved his temporary total disability status. For the following reasons, we affirm the denial of the prescriptive plea and amend the disability finding.

FACTS

Davis was involved in a work-related accident on April 5, 1982 while employed as an operator foreman for Serv-Tech Specialists, Inc., an industrial service company specializing in hydroblasting and cleaning of chemical plants and oil refineries. On the day in question, Davis and his work crew were cleaning equipment at the Cities Services oil refinery in Lake Charles. As Davis was pouring an aqua ammonia solution into a tank positioned on a trailer, he was overcome by ammonia fumes, lost his balance and fell to the ground. He landed on the right side of his body and felt pain mainly in his knee and wrist. His supervisor, Garrett Monk, witnessed the fall. The incident was reported to his employer at its Lake Charles office, but Davis did not miss any work immediately thereafter.

A few days later, Davis experienced increased pain and swelling in his right knee. Valerie Balzoni, Serv-Tech's office manager, referred him to the Grimball and Richert Clinic, which had been retained by Serv-Tech to provide medical services to its employees. Serv-Tech represented to Dr. Allen *575 Richert, Sr. that Davis was a worker's compensation patient. On June 21, 1982, he was examined by Dr. Richert, who diagnosed effusion, a collection of fluid secondary to an injury, and bursitis. Richert aspirated Davis' knee and prescribed an anti-inflammatory drug. Either Richert or Grimball saw Davis on four more occasions until they released him on July 24, 1982. With the exception of the days of work missed to see the doctors, Davis continued to perform his work duties and was paid therefor despite the continued pain and swelling. Davis' job, in part, entails lifting of high pressure water hoses which weigh between 50 and 75 pounds and climbing ladders attached to plant towers in order to reach the higher areas for cleaning purposes. These two activities, lifting and climbing, tended to exacerbate the pain and swelling in his knee.

In July, 1982, Serv-Tech laid Davis off. He moved to his home state of Tennessee and, while there, his family doctor aspirated his knee once. In April, 1983, Davis moved back to Lake Charles and began working for Serv-Tech again. His knee problems were not resolved, and he saw Dr. Richert three times between December 30, 1983 and August, 1984. Davis missed over a week of work on the advice of Dr. Richert following the December 30, 1983 visit. He was not paid wages or compensation benefits. Balzoni informed both United General Insurance Company, Serv-Tech's worker's compensation carrier, and American International Adjustment Company, the claims adjuster, of Davis' entitlement to compensation by letters dated January 12, 1984 and February 3, 1984, respectively. United General responded with a request for a medical records authorization from Davis. No further correspondence was received by Serv-Tech from United General.

Dr. Richert referred Davis to Dr. David Drez, an orthopedic surgeon. Upon receiving the referral, Dr. Drez's office contacted Serv-Tech to obtain Davis' worker's compensation claim number. Wayne Lebert, Serv-Tech's Lake Charles district manager, was surprised to discover that Davis had not been assigned a claim number. With a call to the Grimball and Richert Clinic, Lebert discovered that Davis had no claim number on file there and that his medical expenses had been paid by Serv-Tech company checks. Dr. Drez refused to treat Davis without the issuance of a worker's compensation claim number or some other guarantee of payment.

Lebert next contacted Martha Calvin in Serv-Tech's Houston corporate office. She informed him that the injury would not be covered as a worker's compensation claim because, in her view, it had not been timely reported to either the corporate office or United General.

Lebert next spoke with Buster Austin, Serv-Tech's vice-president, who agreed that Davis' worker's compensation coverage problem was the result of a "paperwork malfunction". He agreed verbally that, if Davis were to seek coverage for further treatment under the company's group health insurance, Serv-Tech would pay his deductible and 20% copayment. In the meantime, Austin promised to clear up the "paperwork malfunction" and assured Lebert that Davis would be covered under the worker's compensation policy.

Apparently, this resolution satisfied both Davis and Dr. Drez, who first examined Davis' knee on November 5, 1984 and performed arthroscopic surgery on the knee three days later. The surgery revealed a condition known as pigmented villondular synovitis, an abnormal growth of knee joint tissue. Davis saw Dr. Drez again on November 28, 1984 and December 26, 1984, at which time minimal swelling and overall improvement were noted. Due to the surgery, Davis was not working but was paid his regular wages based on a 40 hour work week until his return on December 6, 1984.

In December, 1984, Lebert discovered that Davis was not enrolled in Serv-Tech's group health insurance plan and could not seek coverage thereunder for his medical expenses. Despite his personal impression that Serv-Tech was responsible for Davis' injury, Lebert informed Davis that Serv-Tech's corporate office stood firm in its position that his medical expenses were not covered by either health insurance or worker's compensation.

*576 In early 1985, Davis consulted an attorney, who made demand upon Serv-Tech and United General. When this effort failed, Davis filed suit against United General on September 11, 1985 seeking payment of weekly compensation benefits, medical expenses, penalties and attorney's fees. United General answered the suit and filed an exception of prescription. Davis continued to work for Serv-Tech until he was once again laid off on February 10, 1986. He moved back to Tennessee and began working as a truck driver for VAMAC, a freight hauling company.

On November 12, 1986, Davis added Serv-Tech as a party defendant. In 1987, the Louisiana Insurance Commissioner placed United General into liquidation. Davis then added LIGA as a party defendant on November 17, 1987.

After lengthy discovery, trial of this matter was held on September 11, 1992. At the commencement of the proceedings, the parties stipulated that Davis was involved in a work-related accident on April 5, 1982 and that his compensation rate would be $183.00 weekly. At the time of trial, he was still employed by VAMAC as a truck driver. After trial, the court took the case under advisement.

On January 4, 1993, the trial judge rendered written reasons for judgment wherein he concluded that the one-year prescriptive period for filing a claim, La.R.S.

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Bluebook (online)
631 So. 2d 572, 93 La.App. 3 Cir. 738, 1994 La. App. LEXIS 228, 1994 WL 28637, Counsel Stack Legal Research, https://law.counselstack.com/opinion/davis-v-united-general-ins-co-lactapp-1994.