Fusilier v. Slick Const. Co.

640 So. 2d 788, 94 La.App. 3 Cir. 11, 1994 La. App. LEXIS 1630, 1994 WL 234323
Louisiana Court of Appeal·Decided June 1, 1994·No. 94-11·Published·Cited by 31 cases

Opinion

640 So.2d 788 (1994)

Todd FUSILIER, Plaintiff-Appellant,
v.
SLICK CONSTRUCTION COMPANY, et al., Defendants-Appellees.

No. 94-11.

Court of Appeal of Louisiana, Third Circuit.

June 1, 1994.

*790 Michael Benny Miller, for Todd Fusilier.

Leah Hipple McKay, for Slick Const.

Before KNOLL, THIBODEAUX and SAUNDERS, JJ.

THIBODEAUX, Judge.

This is a workers' compensation case. Todd Fusilier appeals the judgment of a hearing officer with the Louisiana Office of Workers' Compensation denying him supplemental earnings benefits, penalties and attorney fees. His ex-employer, Slick Construction Company, and its insurer, Liberty Mutual Insurance Company, appeal penalties assessed against them by the hearing officer for failure to timely produce medical records and failure to pay all of Fusilier's medical bills.

For the following reasons, we affirm the denial of SEB and the award of penalties of $250.00 for defendant's failure to timely produce medical records, award attorney's fees of $1,000.00 for that same violation, and reverse the penalty award of $750.00 for Liberty Mutual's failure to pay all of the medical bills. And, finally, we award additional compensation benefits of $154.77.

ISSUES

Fusilier raises the following issues:
1) Whether he is entitled to SEB due to a job-related back injury;
2) Whether the benefits he received were properly calculated; and
3) Whether defendants were arbitrary and capricious.
Defendants raise the following issues:
1) Whether they were arbitrary and capricious in failing to pay the full amount of Dr. Heard's medical bill; and
2) Whether they were arbitrary and capricious in failing to produce Fusilier's medical records within the statutorily mandated time.

FACTS

On October 2, 1990, Fusilier fell into a hole while in the course and scope of his employment with Slick. He immediately complained of pain in his knee, upper thighs, groin and pelvis area. He was examined by Dr. Brian Heinen on the day of the accident and was initially diagnosed with a hamstring pull. He was examined by Dr. Heinen again on October 5, and a hernia was discovered. He was then scheduled for surgery with a Dr. Landreneau. Prior to the operation, he complained to Dr. Landreneau about back pain and x-rays were taken which revealed no objective findings. However, a preoperative exam revealed a second hernia, and both were repaired successfully.

Some complications arose from the surgery and Fusilier was referred to a urologist. He was dissatisfied with the urologist and asked to be and was examined by another physician, a general practitioner, Dr. Manuel. Dr. Heinen released him to light duty work on November 6, 1990. On November 21, 1990, the temporary total benefits were terminated. On November 27, Dr. Manuel issued a written report to Slick affirming that Fusilier was capable of light duty work. Slick offered him light duty work at the same hourly wage and the same hours as before the accident. On December 3, 1990, he rejected the offer and either quit or was terminated.

Fusilier then searched for and found work. For six to seven months he delivered parts for Craig's Automotive; he worked briefly as a mechanic for Superior Tune; and, finally, as a laborer for Gulfgate Marine until January of 1993.

*791 Fusilier filed a claim for benefits, penalties and attorney fees against defendants in January 1992. In July of 1992, he was examined by Dr. Michael Heard who found no objective evidence of a back injury but related whatever back pain suffered by Fusilier to the October 2 accident. Dr. Heard was of the opinion that Fusilier could not work as a laborer but could do light duty work based on his subjective complaints of back pain.

The matter went before the hearing officer who determined that Fusilier did not prove he suffered from a job-related back injury or that he was incapable of making at least ninety percent of his pre-injury wages. The hearing officer did assess penalties of $750.00 against defendants for failing to pay $95.00 of a $400.00 medical bill submitted by Dr. Heard. She also assessed penalties of $250.00 against defendants because they failed to submit medical records to Fusilier within the time mandated by statute. No attorney fees were awarded.

LAW AND ANALYSIS

I. Injury & Benefits

Fusilier claims he is owed SEB from November 21, 1990 until present. The court recently summarized the purpose of supplemental earnings benefits in Allen v. City of Shreveport 618 So.2d 386, 388 (La. 1993):

Supplemental earnings benefits were established in 1983 as a method of replacement of lost wages for partially disabled employees. The benefits are designed to replace lost earning capacity of workers who do not fall under the definition of total disability. When an injured employee is able to engage in a gainful occupation, but because of his work-related disability is unable to earn wages at the level he was earning prior to his injury, he is classified as partially disabled. And when the partial disability reaches the level that the employee is unable to earn wages equal to ninety percent or more of the wages he was earning at the time of the injury, he is entitled to supplemental earnings benefits, calculated according to a formula relating to his pre-injury wages and the wages he `is able to earn' in any employment or self-employment after the injury. La.Rev.Stat. 23:1221(3)(a). (Footnote omitted).

Claimant bears the initial burden of proving by a preponderance of the evidence that a work related injury prevents him from earning ninety percent or more of his pre-injury wages. Tassin v. CIGNA Insurance Company, 583 So.2d 1222 (La.App. 3d Cir.1991). Where the claimant has been released to light duty work and refuses his employer's offer of light duty work at the same wage and hours, he is not entitled to SEB. Augustine v. Paul Well Truck Line, Inc., 603 So.2d 770 (La.App. 3d Cir.), writ denied, 608 So.2d 193 (La.1992); Tanner v. International Maintenance Corporation, 602 So.2d 1133 (La.App. 1st Cir.1992).

The record holds two revelations fatal to Fusilier's case. The first is that he was offered a light duty position by Slick at the same wage and hours. He rejected this position without attempting to perform the work offered. The second is that he held three jobs in which he was paid at least the same hourly wage (and, in one instance more), and for at least five months earned as much or more than he was earning at Slick. Furthermore, he voluntarily quit these jobs for reasons unrelated to health problems. Not only does this evidence prove he is capable of performing a job in which he makes at least ninety percent of his pre-injury wage but it proves he actually worked at jobs making as much or more than his pre-injury wage. We can think of no better defense against payment of SEB under the circumstances of this case.

The hearing officer found that Fusilier suffered neither a work-related nor a disabling back injury. Her findings were based on the absence of objective evidence of a back injury and the fact that, although Dr. Heard related Fusilier's back pain to the October 2 accident, the relation was based solely on Fusilier's subjective complaints and his version of events.

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Fusilier v. Slick Const. Co., 640 So. 2d 788, 94 La.App. 3 Cir. 11, 1994 La. App. LEXIS 1630, 1994 WL 234323 (La. Ct. App. 1994).

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