Gross v. Maison Blanche, Inc.

732 So. 2d 147, 98 La.App. 4 Cir. 2341, 1999 La. App. LEXIS 1516, 1999 WL 314923
CourtLouisiana Court of Appeal
DecidedApril 21, 1999
Docket98-CA-2341
StatusPublished
Cited by9 cases

This text of 732 So. 2d 147 (Gross v. Maison Blanche, Inc.) 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
Gross v. Maison Blanche, Inc., 732 So. 2d 147, 98 La.App. 4 Cir. 2341, 1999 La. App. LEXIS 1516, 1999 WL 314923 (La. Ct. App. 1999).

Opinion

732 So.2d 147 (1999)

Marie GROSS
v.
MAISON BLANCHE, INC.

No. 98-CA-2341.

Court of Appeal of Louisiana, Fourth Circuit.

April 21, 1999.

*148 Anthony J. Russo, Dean J. Favret, Favret, Demarest, Russo & Lutkewitte, New Orleans, Louisiana, Attorneys for Plaintiff/Appellee.

Kenny M. Charbonnet, William V. Renaudin, Jr., Metairie, Louisiana, Attorneys for Defendant/Appellant.

Court composed of Judge MOON LANDRIEU, Judge JAMES F. McKAY III, Judge JAMES A. GRAY II.

McKAY, Judge.

The defendant Maison Blanche appeals an adverse ruling from a judgment arising from a worker's compensation claim by Marie Gross, an employee of Maison Blanche, Inc., and rendered in her favor.

On June 11, 1998, the Compensation judge, found the defendant Maison Blanche arbitrary and capricious based on its termination of Ms. Gross' weekly wage benefits, refusal of medical treatment and refusal to authorize a second neurological opinion. Pursuant to La. R.S. 23:1201(E); the trial court awarded attorney's fees in the amount of $7,500.00 plus statutory penalties. On July 9, 1998, the trial court rendered Reasons for Final Judgment as follows:

"... [D]efendant offered no proof of its reasons for not reinstating and/or failing to reinstate worker's compensation benefits after it received the negative report from claimant's doctor indicating her disability status and need for further neurological testing. Defendant relied on previously obtained medical opinions, which it is not entitled to do under law. Defendant failed to further investigate the request for medical treatment and indemnity benefits but instead relied on earlier obtained medical opinions. This was arbitrary and capricious conduct by defendant."

On October 25, 1996, plaintiff, while acting in the course and scope of her employment as a cosmetician at Maison Blanche, received an electrical shock from a cosmetic display counter. As a result of the shocks plaintiff was thrown against an upright case and allegedly sustained injuries to her head, neck and spine. She was initially treated for one week with her employee's physician, Dr. Axelrod, for complaints of headaches, shooting pains down her right shoulder and arm as well as pain in her back and right leg. He prescribed muscle relaxers and placed her on no work status until October 30, 1996. He recommended physical therapy but advised her that she could return to work on November 4, 1996.

Thereafter she treated with her orthopedic surgeon Dr. Bourgeois for the alleged injuries to her head, neck and back. He diagnosed her as suffering from an electrocution injury with cervical, thoracic and lumbar myofascial strain and hamstring strain on her left side. He placed her on no work status from October 31, 1996 *149 through January 7, 1997. In January of 1997, Dr. Bourgeois referred Ms. Gross to Dr. Trahant, a neurologist. He treated her for continued complaints of headaches and vertigo from January 1997 through May 7, 1997. When he found no neurological improvements he recommended that she seek a second neurological opinion and on May 7, 1997, he discharged her to return to work. Based on Dr. Trahant's May 7, 1997 report, Maison Blanche terminated Ms. Gross weekly wage benefits and refused to authorize a second neurological opinion.

Dr. Bourgeois continued to treat Ms. Gross from May 1997, through April of 1998. He continually sent progress reports to Maison Blanche's adjuster, Ms. Dodd, apprising her that Ms. Gross was still on no work status. Additionally, he continued to recommend physical therapy for Ms. Gross, to which Maison Blanche was unresponsive. Furthermore, Maison Blanche continued to pay him for his medical services throughout his treatment of Ms. Gross.

On June 27, 1997, counsel for Ms. Gross forwarded a letter to Ms. Dodd demanding a reinstatement of wage benefits to Ms. Gross. Thereafter, counsel forwarded by certified mail to Ms. Dodd a supplemental report from Dr. Trahant, dated September 17, 1997, wherein he specifically yielded to the opinion of Dr. Bourgeois concerning Ms. Gross inability to return to work. In this correspondence counsel again requested that plaintiff's weekly wage benefits be reinstated and requested authorization for a second neurological opinion. Maison Blanche did not authorize the physical therapy until February 8, 1998, and the authorization for a second neurological opinion was not verified until March 11, 1998. Furthermore, Ms. Gross was not reinstated to her weekly wage benefits until March 23, 1998, after the instant suit was filed. On March 23, 1998, the workers' compensation carrier reinstated Ms. Gross' benefits and issued a check in the amount of $9,609.86 representing the past due and owing wage benefits from May 7, 1997, through March 23, 1998, a period of 320 days after terminating Ms. Gross' benefits.

The sole issue at trial was whether Maison Blanche acted arbitrary and capricious in refusing to authorize a second neurological opinion, in refusing to authorize physical therapy and in terminating Ms. Gross' weekly wage benefits from May 7, 1997 through, March 23, 1998.

STANDARD OF REVIEW

The determination of whether an employer should be cast with penalties and attorney's fees in a workers' compensation case is essentially a question of fact and the trial court's findings shall not be disturbed at the appellate level absent manifest error. Price v. City of New Orleans, 95-1851 (La.App. 4 Cir. 3/27/96), 672 So.2d 1045, writ denied 96-1016 (La.10/25/96), 681 So.2d 360.

ASSIGNMENT OF ERRORS:

The appellant alleges, that the Worker's Compensation judge erred in finding Maison Blanche arbitrary and capricious based on the following: failing to reinstate wage benefits to the claimant, failing to re-investigate the medical status of claimant after receiving a negative report from her neurologist, refusing to authorize a second neurological evaluation and failing to authorize physical therapy. The appellant also alleged that the hearing officer erred in awarding attorney's fees and penalties.

LAW

La. R.S. 23:1201(F) in pertinent parts provides that:

[F]ailure to provide payment in accordance with this Section shall result in the assessment of a penalty..., together with reasonable attorney fees for each disputed claim...
§ 1 "Such penalties and attorney's fees shall be assessed against the employer or the insurer, depending upon fault..." *150 La. R.S. 23:1201.2 in pertinent part provides that:
[A]ny employer or insurer who at any time discontinues payment of claims due and arising under this Chapter, when such discontinuance is found to be arbitrary, capricious, or without probable cause, shall be subject to the payment of all reasonable attorney fees for the prosecution and collection of such claims...

ARGUMENT

In the instant case the defendant relied on the medical discharge by only one of Ms. Gross treating physicians to base their discontinuance of her weekly wage benefits. From the record, it is clear that the defendants were aware that there was another treating physician, Dr. Bourgeois, whom the defendant consistently paid for medical services rendered to Ms. Gross. He was also steadfast in his recommendation that she remain on a no work status. An employer must demonstrate that reasonable efforts were made to ascertain the worker's exact condition before denying benefits and employers have an ongoing duty to review medical reports concerning disability. Blanque v. City of New Orleans, 92-1313, 612 So.2d 948 (La.App. 4 Cir.

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Bluebook (online)
732 So. 2d 147, 98 La.App. 4 Cir. 2341, 1999 La. App. LEXIS 1516, 1999 WL 314923, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gross-v-maison-blanche-inc-lactapp-1999.