Edwards v. Hartford Ins. Co.

445 So. 2d 499, 1984 La. App. LEXIS 7925
CourtLouisiana Court of Appeal
DecidedJanuary 16, 1984
Docket15953-CA
StatusPublished
Cited by11 cases

This text of 445 So. 2d 499 (Edwards v. Hartford 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
Edwards v. Hartford Ins. Co., 445 So. 2d 499, 1984 La. App. LEXIS 7925 (La. Ct. App. 1984).

Opinion

445 So.2d 499 (1984)

Charles EDWARDS, Plaintiff-Appellant,
v.
The HARTFORD INSURANCE COMPANY, Defendant-Appellee.

No. 15953-CA.

Court of Appeal of Louisiana, Second Circuit.

January 16, 1984.

*500 Cook, Yancey, King & Galloway by Charles G. Tutt, Shreveport, for defendant-appellee.

Ike F. Hawkins, Jr., Shreveport, for plaintiff-appellant.

Before JASPER E. JONES, FRED W. JONES, Jr., and SEXTON, JJ.

JASPER E. JONES, Judge.

A judgment was rendered awarding plaintiff, Charles Edwards, workers' compensation benefits for permanent scarring to his face and rejecting his claim for penalties and attorney's fees. Plaintiff appeals the judgment insofar as it rejects his demand for penalties and attorney's fees. The defendant, The Hartford Insurance Co., neither appealed the judgment nor answered plaintiff's appeal.

The plaintiff, while driving a truck for defendant's insured, was injured in an accident at approximately 3:00 p.m. on December 4, 1981 in Many, Louisiana. Plaintiff suffered extensive facial lacerations, among other injuries, in the accident. A doctor in Many referred plaintiff to Dr. Judd Chidlow, a plastic surgeon in Shreveport, for treatment of his facial injuries.

Plaintiff met Dr. Chidlow in the emergency room at Highland Hospital in Shreveport at approximately 5:30 p.m. the day of the accident. Dr. Chidlow described plaintiff as having one of the most extensive facial injuries he had ever treated. The lacerations required from 400 to 500 stitches. Dr. Chidlow gave the following description of plaintiff's injuries in response to questions from plaintiff's attorney in a deposition taken October 25, 1982.

Q. Could you describe the lacerations and the extent of the lacerations to his face, particularly?
A. Yes, sir, primary ones he had, about a two centimeter vertical laceration through his lower lip. He had a five centimeter laceration of the upper lip starting just at the base of the columella *501 of the nose going all the way down to the maxilla and going out into the left cheek. The whole thing was approximately seven centimeters in diameter. The commissure of the left side of his mouth was completely torn out. He had an avulsion of two centimeters defect just below and lateral left lower eyelid, which had underminded down on his cheek. He had a four centimeter laceration of the center of his left cheek. He had about a three centimeter laceration of the left cheek below this. He had a stellate three centimeter laceration in his tongue, the left side of the tongue. His upper alveolar, or the upper bony ridge was lacerated, actually had a fracture of the bone above the right central incisor and lateral incisor and canine tooth. He had two small lacerations on the center of his upper lip. In addition, he had a ten centimeter laceration in the left neck and shoulder, and about a five centimeter laceration of his right forearm.
Q. Now I believe that you are reading from a report that you had worked up dated December 4th?
A. That is correct.
Q. Number three on that report says, the lacerations to the upper lip. Now they started at the base of the—
A. This is the columella of the nose (indicating).
Q. That would be the mid-part of the underside of the nose?
A. Yes, sir, and it went up into the nose.
Q. And it ran from there to where?
A. Well, let me read that again to clarify it. Five centimeter laceration starting—laceration to the upper lip, starting just at the base of the columella of the nose, going all of the way down to the maxilla and the bone behind that and going out into the cheek on the left side. So it went out like so (indicating).
Q. Now # 4, the avulsion injury. What did that tear out?
A. Okay, that was an avulsion of about two centimeter defect below the left lateral eyelid, just a piece of tissue was actually just gone from there. We had to swing a flap to bring a piece back to prevent his eye from being pulled down. He actually lost a piece of tissue in that area.

Dr. Chidlow answered these questions by reading from a report that he made on the date of plaintiff's accident. There is no indication in the record that defendant ever received this report.

Plaintiff was off work for approximately 7 weeks after the accident. During that period of time defendant paid him weekly benefits totalling $1,333.28. Defendant also paid plaintiff's medical expenses. When plaintiff returned to work his weekly benefit payments were terminated and he secured the services of an attorney. The attorney made numerous demands on defendant to resume paying weekly benefits to plaintiff for the scars on his face. The defendant repeatedly refused and suit was filed July 9, 1982. On October 4, 1982 defendant tendered a $5,500.00 check to plaintiff which he apparently accepted.[1] The matter came to trial March 9, 1983.

By stipulation of the parties the only injury to plaintiff at issue in the trial was the facial scarring. At the close of the trial, the trial court awarded plaintiff $183.00 per week for 100 weeks, which is the maximum benefits that could have been awarded.[2] Since the amount of the award is not questioned by either party, this appeal is limited to the issue of whether the trial court properly rejected plaintiff's claim for penalties and attorney's fees.

The failure of a workers' compensation insurer to pay a claim due within 60 days after satisfactory proof of the injury *502 from the injured employee subjects the insurer to a statutory penalty of 12% interest and reasonable attorney's fees where the failure to pay is found to be arbitrary, capricious or without probable cause. La. R.S. 22:658.[3] See also R.S. 23:1201.2. The question of whether penalties and attorney's fees will be awarded for termination of benefit payments is subject to the same arbitrary and capricious standard. See Johnson v. State Farm Mut. Auto. Ins. Co., 342 So.2d 664 (La.1977); Johnson v. Continental Ins. Companies, 410 So.2d 1058 (La.1982).

Whether or not a termination of or refusal to pay benefits is arbitrary, capricious or without probable cause depends primarily on the facts known to the insurer at the time of its action. Lee v. Smith, 248 La. 16, 176 So.2d 413 (1965); Arthur v. McConnell, 286 So.2d 499 (La.App. 2d Cir. 1973); Hughes v. Webster Parish Police Jury, 414 So.2d 1353 (La.App. 2d Cir.1982); Scott v. Sears, Roebuck & Co., 406 So.2d 701 (La.App. 2d Cir.1981). The question is ultimately one of fact and the trial court's finding should not be disturbed on appeal absent manifest error. Scott v. Sears, Roebuck & Co., supra; Kilbourne v. Armstrong, 351 So.2d 802 (La.App. 1st Cir. 1977).

Defendant claims its termination of benefit payments was not arbitrary, capricious or without probable cause because the facts known by it at the time established legitimate questions as to whether any benefits were owed and if and when it became apparent that benefits were owed the amount of such benefits.[4]

An injured employee who sustains facial scars from a job related accident may recover compensation benefits under La.R.S. 23:1221(4)(p) which provides:

In cases not falling within any of the provisions already made, where the employee is seriously permanently disfigured

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Bluebook (online)
445 So. 2d 499, 1984 La. App. LEXIS 7925, Counsel Stack Legal Research, https://law.counselstack.com/opinion/edwards-v-hartford-ins-co-lactapp-1984.