Jeanne Terrebonne v. St. Tammany Parish Hospital

CourtLouisiana Court of Appeal
DecidedJuly 20, 2022
Docket2021CA1212
StatusUnknown

This text of Jeanne Terrebonne v. St. Tammany Parish Hospital (Jeanne Terrebonne v. St. Tammany Parish Hospital) 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
Jeanne Terrebonne v. St. Tammany Parish Hospital, (La. Ct. App. 2022).

Opinion

STATE OF LOUISIANA

COURT OF APPEAL

FIRST CIRCUIT

2021 CA 1212

JEANNE TERREB ONNE

VERSUS

ST. TAMMANY PARISH HOSPITAL

Judgment Rendered: JUL 2 0 2022

On Appeal from the Office of Workers' Compensation, District 6 In and for the Parish of St. Tammany State of Louisiana Number 19- 02594

R. Myles Donahue, Presiding

Suzette Tagesen Murphy Counsel for Plaintiff/Appellee, Metairie, Louisiana Jeanne Terrebonne

John J. Rabalais Counsel for Defendant/ Appellant, Matthew D. Crumhorn St. Tammany Parish Hospital Megan C. Gladner Covington, Louisiana

BEFORE: THERIOT, PENZATO, AND RESTER, JJ. PENZATO, J.

In this workers' compensation case, the defendant/employer appeals the

portion of a judgment rendered on June 28, 2021, in favor of the

claimant/ employee and against the defendant. Specifically, the defendant seeks

reversal of the portion of the judgment that awarded a penalty to the claimant in the

amount of $8, 000.00 and attorney fees in the amount of $12, 000. 00 pursuant to La.

R.S. 23: 1201( I). For the following reasons, we affirm.

The claimant timely filed an answer to the appeal pursuant to La. C. C. P. art.

2133, seeking an award of costs and attorney fees incurred opposing the appeal.

Because we affirm all portions of the judgment in the claimant' s favor and against

the defendant, we grant the relief requested in the claimant' s answer and award

1, 500. 00 in attorney fees to the claimant on appeal.

FACTS AND PROCEDURAL HISTORY

The claimant, Jeanne Terrebonne, filed a 1008 Disputed Claim for

Compensation on April 22, 2019, alleging that her employer, St. Tammany Parish

Hospital, denied medical benefits for her work-related injury. She sought

penalties, attorney fees, costs, and interest. The Hospital filed an answer on May

6, 2019, admitting that Ms. Terrebonne sustained an injury on January 5, 2016

while in the course and scope of her employment. However, the Hospital denied

that Ms. Terrebonne met the initial burden of " proving entitlement to current

medical treatment" and denied that she was entitled to medical benefits based on

her failure to seek medical treatment since March 29, 2017.

The matter proceeded to trial on May 10, 2021, to determine whether Ms.

Terrebonne was entitled to penalties and attorney fees because the Hospital either

failed to timely approve her claim for medical benefits or it arbitrarily,

capriciously, and without probable cause denied or discontinued payment of her

claim through its adjuster, Alan Daigrepont. La. R.S. 23: 1201( E), ( F), and ( I). The

2 workers' compensation court also considered the Hospital' s motion to dismiss Ms.

Terrebonne' s claim premised on the argument that she failed to file a LWC Form

1010 request for treatment in violation of the procedural requirements set forth in

the Louisiana Administrate Code. LAC 40: I.2715( D)( 2)( a).

Facts Established at Trial

Ms. Terrebonne injured her right wrist and forearm in January 2016 while

performing her duties as a nurse for the Hospital. The Hospital initially provided

workers' compensation medical benefits to Ms. Terrebonne and approved her

selection of treating orthopedic surgeon, Dr. Brandon Donnelly. Ms. Terrebonne

treated with Dr. Donnelly until her follow-up appointment on March 29, 2017.

Between March 2017 and January 2019, Ms. Terrebonne did not receive

medical treatment, because her symptoms were not " severe enough" to cause her to

seek treatment. However, her symptoms increased in January 2019, prompting her

to contact Dr. Donnelly' s office to schedule an appointment. The doctor' s office

advised Ms. Terrebonne that workers' compensation authorization was needed to

schedule an appointment. Ms. Terrebonne contacted her attorney, Suzette Murphy,

who contacted Mr. Daigrepont, the adjuster assigned to handle Ms. Terrebonne' s

workers' compensation claim by the Hospital' s third -party administrator.

Ms. Murphy faxed a letter to Mr. Daigrepont on January 31, 2019,

explaining that her client, Ms. Terrebonne, sought to return to Dr. Donnelly for

medical treatment and that Dr. Donnelly' s office must be given authorization to

make an appointment. The letter stated, " Please accept this as our demand to

authorize a return appointment."

Mr. Daigrepont responded to Ms. Murphy' s letter via email on February 1,

2019. He acknowledged receiving Ms. Murphy' s letter and provided a brief

summary of Ms. Terrebonne' s January 2016 injury and treatment history, including

her last appointment with Dr. Donnelly in early 2017. Mr. Daigrepont then stated, I would like to suspend the authorization you request, if you will provide answers

to a few questions for me." He inquired as to whether Ms. Terrebonne had any

medical treatment in the last two years for this work injury, why she was

demanding treatment now if she has not received treatment in the last two years,

and whether Ms. Terrebonne was involved in any " accidents ( WC / GL / Auto)"

within the last two years. Mr. Daigrepont concluded, " These and many more

questions bring rise to the validity of complaints.... Please be so kind as to answer

these questions and I will consider your request for an office visit with Dr

Donnelly." At trial, Mr. Daigrepont testified that, when he received Ms. Murphy' s

letter, he " questioned the validity" of Ms. Terrebonne' s request and need for

treatment due to the time that had passed since her last visit with Dr. Donnelly.

Ms. Murphy responded to Mr. Daigrepont via email on March 26, 2019. She

explained, " I am seeing this response today as you were in my spam folder."

Replying to Mr. Daigrepont' s questions, Ms. Murphy stated that Ms. Terrebonne

had not received any other treatment and " has not been involved in any new

accidents or injuries." Ms. Murphy did not respond to Mr. Daigrepont' s question

concerning why Ms. Terrebonne was seeking treatment now, but she stated that

Ms. Terrebonne spoke informally to a physician she works with regarding her

symptoms. Ms. Murphy again requested, " Please authorize the return office visit."

At trial, Mr. Daigrepont admitted that he did not respond to Ms. Murphy' s

March 26, 2019 email "[ o] ut of frustration because [ she] had not answered any of

the questions I had posed prior." In Mr. Daigrepont' s opinion, Ms. Murphy did not

respond to his questions, because " there was no supporting documentation that was

asked [ of her]." Although Mr. Daigrepont did not specifically ask Ms. Murphy to

provide documentation to support her responses to his questions, he testified that

he believed his questions were " self-explanatory that they required some sort of

documentation." Finally, Mr. Daigrepont dismissed Ms. Murphy' s explanation that

4 his February 1, 2019 email went to her email' s spam folder as an " excuse" for her

delay.

Ms. Murphy emailed Mr. Daigrepont again on April 12, 2019 to follow up,

asking, " Was a return office visit authorized?" Mr. Daigrepont responded to Ms.

Murphy the same day, stating in part, " Quite frankly, I' ve been ignoring this

request on the grounds that it is completely unreasonable." Notably, though, Mr.

Daigrepont pointed out that when Ms. Terrebonne last saw Dr.

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Jeanne Terrebonne v. St. Tammany Parish Hospital, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jeanne-terrebonne-v-st-tammany-parish-hospital-lactapp-2022.