Gay v. Georgia Pacific Corp.

754 So. 2d 1101, 1999 La. App. LEXIS 3632, 1999 WL 1222790
CourtLouisiana Court of Appeal
DecidedDecember 22, 1999
Docket32,653-WCA
StatusPublished
Cited by29 cases

This text of 754 So. 2d 1101 (Gay v. Georgia Pacific Corp.) 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
Gay v. Georgia Pacific Corp., 754 So. 2d 1101, 1999 La. App. LEXIS 3632, 1999 WL 1222790 (La. Ct. App. 1999).

Opinion

754 So.2d 1101 (1999)

Marcellus GAY, Plaintiff-Appellee,
v.
GEORGIA PACIFIC CORPORATION, Defendant-Appellant.

No. 32,653-WCA.

Court of Appeal of Louisiana, Second Circuit.

December 22, 1999.

*1102 Jack M. Bailey, Jr., By Jack M Bailey, J. Allen Cooper, Jr., J. Chris Miciotto, Shreveport, Counsel for Plaintiff-Appellee.

Juge, Napolitano, Guilbeau & Ruli, By Denis Paul Juge, Frank R. Whiteley, Metairie, Counsel for Defendant-Appellant.

Before NORRIS, C.J., and WILLIAMS and DREW, JJ.

NORRIS, Chief Judge.

In this workers' compensation case, the employer, Georgia Pacific Corporation, appeals from a judgment awarding the claimant *1103 penalties and attorney's fees because the employer denied the claimant's request for an MRI. We affirm.

Background

On December 2, 1992, Marcellus Gay injured his back while working for Georgia Pacific. He subsequently had two surgeries on his back. The more recent surgery was performed by Dr. Jorge Martinez on February 15, 1994.

On March 18, 1998, Gay returned to Dr. Martinez with complaints of back pain. Gay described the pain as sharp and accompanied by a "popping sensation" with radiation to his legs which suddenly appeared one morning as he awoke. The pain was aggravated by every-day activities such as standing, walking, sitting or bending. After examining Gay, Dr. Martinez recommended that he undergo a lumbosacral spine MRI to investigate his complaints.

Gay submitted a request to his employer to approve the MRI. As indicated in the record, despite repeated requests for authorization, Georgia Pacific did not request a Utilization Review from Encompass Health Management Systems, Georgia Pacific's claims manager until July 13, 1998. The record contains a file note from Dr. Martinez stating that on July 15, 1998, he discussed Mr. Gay's condition on the telephone with Dr. Levy and Dr. Oskar Friedlieb, Encompass' physician advisor. Dr. Martinez noted that he informed these doctors that Gay might have a midline ruptured disc and that the MRI was needed to rule out this diagnosis. On July 16, 1998, Encompass recommended against approving the MRI, opining that Gay had reached MMI and that since he was neurologically intact, he did not present as a surgical candidate, thus obviating the need for an MRI. The Encompass physician never examined the claimant, and the record does not contain any medical notes or reports made by the Encompass physician other than his naked conclusion that an MRI was not warranted.

On August 6, 1998, Gay filed the instant disputed claim for compensation (LDOLWC-1008) seeking approval of the MRI and statutory penalties and attorney fees. The WCJ agreed to decide Gay's MRI request on an expedited basis, and reserved the penalties and fees for a later date. On September 8, 1998, the WCJ ordered Georgia Pacific to pay for the MRI, stating:

The Court does not find that the opinion of the employer's utilization review physician is sufficient to outweigh what appears to be the reasonable judgment of the employee's treating physician regarding a necessary course of medical treatment, particularly in view of the fact that there is no evidence that the employee has been examined by the utilization review physician.

In accordance with the WCJ's order, Georgia Pacific approved Gay's MRI. On December 17, 1998, the WCJ rendered judgment on the penalties and attorney fees issue, concluding that Georgia Pacific was arbitrary and capricious in withholding approval of the MRI, and awarded Gay $2,000 in statutory penalties and $1,750 in attorney fees. In written reasons for judgment, the WCJ stated:

The Court finds that the defendant's action in refusing to authorize an MRI was under these circumstances arbitrary, cap[ri]cious and without probable cause and the claim was not reasonably controverted. The defendant's delay in seeking utilization review until some four months after the plaintiffs treating physician's recommendation of the MRI was particularly inexcusable. Further, the medical treatment requested was for a rather standard and simple diagnostic test, namely an MRI. Dr. Martinez was limited in his ability to treat his patient by the defendant insurer's delay in seeking utilization review and its reliance upon a report from a utilization review physician who simply concluded that Mr. Gay was, quote, neurologically intact, end quote.

*1104 Georgia Pacific appeals the award of penalties and fees.

Discussion Applicability of Current Law

By its first assignment of error, Georgia Pacific argues that the law in effect at the time of Gay's accident governs the award of penalties and attorney fees. This is significant because the pre-1993 version of La R.S. 23:1201 would be more favorable to the employer. Gay, on the other hand, argues that the provisions in effect when his employer refused to authorize the MRI should control.

In the case of an injury compensable under the Louisiana Workers Compensation Act, the employer is obligated to furnish necessary medical and surgical treatment. La. R.S. 23:1203 A; Nowlin v. Breck Construction Co., 30,622 (La.App.2d Cir.6/24/98), 715 So.2d 112; Spencer v. Gaylord Container Corp., 96 1230 (La. App. 1st Cir.3/27/97), 693 So.2d 818.

An employer's failure to authorize a medical procedure for an employee otherwise eligible to receive worker's compensation is deemed to be the failure to furnish compensation benefits, thereby triggering the penalty provisions of the Louisiana Worker's Compensation Act. Roach v. Eagle Water, 31,912 (La.App.2d Cir. 5/5/99), 737 So.2d 182, 189; Fisher v. Lincoln Timber Co., 31,430 (La.App.2d Cir.1/24/99), 730 So.2d 973; Ward v. Phoenix Operating Company, 31,656 (La. App.2d Cir.2/24/99), 729 So.2d 109. Awards for penalties and attorney fees are governed by La.R.S. 23:1201 and 1201.2.

On December 2, 1992, the date of Gay's accident, there was no statutory penalty for the failure to pay or authorize medical expenses; only the withholding of compensation subjected an employer to a statutory penalty. The former La. R.S. 23:1201 provided, inter alia:

E. If any installment of compensation payable without an order is not paid within the time period provided in Subsections B, C, or D of this Section, there shall be added to such unpaid installment a penalty of an amount equal to twelve percent thereof, which shall be paid at the same time as, and in addition to, such installment of compensation, unless such nonpayment results from conditions over which the employer or insurer had no control. Whenever the employee's right to such benefits has been reasonably controverted by the employer or his insurer, the penalties set forth in this Subsection shall not apply. The twelve percent additional payment shall be assessed against either the employer or the insurer, depending upon who was at fault in causing the delay.

Act 1003 of 1992, effective January 1, 1993, amended section 1201 to provide expressly that "medical benefits" are included within the protection afforded by the imposition of such penalty to which was added an award of attorney fees:

E. Medical benefits payable under this Chapter shall be paid within sixty days after the employer or insurer receives written notice thereof.
F.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Wilson Senegal v. Esis, Inc.
Louisiana Court of Appeal, 2022
Massey v. Fresenius Medical Care Holding
152 So. 3d 1019 (Louisiana Court of Appeal, 2014)
Cox v. Port Aggregates, Inc.
54 So. 3d 1257 (Louisiana Court of Appeal, 2011)
Edward Cox v. Port Aggregates, Inc.
Louisiana Court of Appeal, 2011
Kelly Nash v. Aecom Technology Corp.
Louisiana Court of Appeal, 2008
Lambert v. Brookshire Grocery Co.
945 So. 2d 918 (Louisiana Court of Appeal, 2006)
Cheryl Lambert v. Brookshire Grocery Company
Louisiana Court of Appeal, 2006
Reynolds Industrial Contractors v. Fox
935 So. 2d 783 (Louisiana Court of Appeal, 2006)
Romero v. Garan's, Inc.
929 So. 2d 258 (Louisiana Court of Appeal, 2006)
Metoyer v. Roy O. Martin, Inc.
895 So. 2d 552 (Louisiana Court of Appeal, 2005)
Pamela Metoyer v. Roy O. Martin, Inc.
Louisiana Court of Appeal, 2005
McGuyer v. Fidelity & Cas. Co. of NY
895 So. 2d 701 (Louisiana Court of Appeal, 2005)
Player v. International Paper Co.
892 So. 2d 781 (Louisiana Court of Appeal, 2005)
Moore v. Conagra Poultry Co.
893 So. 2d 137 (Louisiana Court of Appeal, 2005)
Hawthorne v. Gilbane/General Motors Corp.
889 So. 2d 1204 (Louisiana Court of Appeal, 2004)
Thompson v. the Animal Hosp.
889 So. 2d 1193 (Louisiana Court of Appeal, 2004)
Williams v. Mark Johnson Plumbing
882 So. 2d 1193 (Louisiana Court of Appeal, 2004)
Royals v. Town of Richwood
880 So. 2d 208 (Louisiana Court of Appeal, 2004)
Smith v. Roy O. Martin Lumber Co.
871 So. 2d 661 (Louisiana Court of Appeal, 2004)

Cite This Page — Counsel Stack

Bluebook (online)
754 So. 2d 1101, 1999 La. App. LEXIS 3632, 1999 WL 1222790, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gay-v-georgia-pacific-corp-lactapp-1999.