Kaiser v. Western-Southern Ins. Co.

821 So. 2d 52, 2001 La.App. 5 Cir. 1393, 2002 La. App. LEXIS 1419, 2002 WL 992184
CourtLouisiana Court of Appeal
DecidedMay 15, 2002
Docket01-CA-1393
StatusPublished
Cited by9 cases

This text of 821 So. 2d 52 (Kaiser v. Western-Southern 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
Kaiser v. Western-Southern Ins. Co., 821 So. 2d 52, 2001 La.App. 5 Cir. 1393, 2002 La. App. LEXIS 1419, 2002 WL 992184 (La. Ct. App. 2002).

Opinion

821 So.2d 52 (2002)

Earl A. KAISER, III
v.
WESTERN-SOUTHERN INSURANCE COMPANY.

No. 01-CA-1393.

Court of Appeal of Louisiana, Fifth Circuit.

May 15, 2002.

*53 Earl A. Kaiser, III, Marrero, LA, Appellant in Proper Person, Brief prepared by Julie G. Kaiser, due to Earl A. Kaiser, III's inability to compose and type himself because of his physically and mentally disabled conditions.

John J. Rabalais, Janice B. Unland, Robert T. Lorio, David S. Pittman, Rabalais, Unland & Lorio, Covington, LA, for Appellee, Western-Southern Life Insurance Company.

Panel composed of Judges JAMES L. CANNELLA, THOMAS F. DALEY and CLARENCE E. McMANUS.

CANNELLA, Judge.

Plaintiff, Earl Kaiser, III, in proper person, appeals a judgment in a workers' compensation case denying reinstatement of workers' compensation benefits from his employer, Western Southern Life Insurance Company. We affirm.

The Plaintiff suffered two automobile accidents while in the course and scope of his employment as a debit salesman for the Defendant. The first occurred in 1988 and the second in 1990. He did not file a workers' compensation claim following the first accident. After the second accident, in March of 1990, the Plaintiff began receiving workers' compensation indemnity and medical benefits. He did not return to work after that accident.

Over the course of several years, the Plaintiff underwent four back surgeries. The last was in 1995. Prior to that surgery, in 1992, he was awarded social security disability benefits. In 1994, the workers' *54 compensation indemnity benefits were converted to supplemental earnings benefits (SEBs). In 1995, following the last surgery, the Defendant reinstated the workers' compensation indemnity benefits. Those were again converted to SEBs in 1999, based on the employer's determination that there were jobs available that he could perform.

On May 6, 1999, the Defendant filed a disputed claim with the Office of Workers' Compensation to reduce the benefits due to the Plaintiff's refusal to cooperate with vocational rehabilitation efforts. On May 24, 1999, the workers' compensation judge ordered the Plaintiff to cooperate, but denied the Defendant's motion to reduce benefits. In February of 2000, the Defendant filed a motion to terminate benefits, which was denied. In June of 2000, the Plaintiff filed a reconventional demand for medical bills from the accident in 1988 to be paid.

The Defendant terminated the SEBs benefits in July of 2000, but continued to pay the Plaintiff's medical bills. By this date, the Plaintiff had received SEBs for 536 weeks, 16 weeks more than the maximum of 520 weeks. See: La.R.S. 23:1221(3)(d).[1] The Plaintiff responded with a supplemental reconventional demand for reinstatement of the original indemnity benefits, medical payments, penalties, and attorneys fees.

A trial of the Plaintiff's entitlement to disability benefits, medical payments penalties, and attorney's fees was held on March 5, 2001. On May 15, 2001, the workers' compensation judge ruled in favor of the Defendant. In the judgment he found that the Plaintiff had reached maximum medical improvement (MMI), but is capable of working at a sedentary level. He further concluded that the Plaintiff is not entitled to any further indemnity or medical benefits of any kind because the Plaintiff failed to prove by clear and convincing evidence that he is totally and permanently disabled. The judgment further denied payment of certain medical bills on the basis that they were either not related to the 1990 accident or not properly submitted on the HCFA 1500 forms, which he found are specifically required by law for the submission of medical bills in workers' compensation cases, under Title 40, Part I, Chapter 51 of the Workers's Administrative Rules. The judgement also states that the Plaintiff failed to cooperate with vocational rehabilitation, was not a credible witness, and that any claims for reimbursement for benefits arising out of the December 6, 1988 accident is prescribed. Costs of the proceedings were assessed against the Plaintiff.

The Plaintiff filed an appeal in proper person. We interpret his brief to assert that the trial judge erred in these findings.

The medical testimony and reports show that the Plaintiff incurred a serious lumbar disc back injury that was either caused by or aggravated by the 1990 accident. Following the 1990 accident, he underwent a discectomy, which failed and necessitated a second surgical intervention in 1991. He underwent a percutaneous laser discectomy in 1992, and a lumbar fusion in 1995. After the fourth surgery, he was diagnosed with "failed back syndrome," which means that the corrections made by the prior surgeries failed. He now has scarring in the lumbar area, his nerves are impinged, and his spine is now unstable.

The various doctors involved in his treatment over the years agree that he continues to have pain and that there is nothing that they can do to cure it. Thus, he has reached MMI. He has been treated *55 with drugs and trigger point injections into the spine, which relieve his pain temporarily. The possibility of a spinal cord stimulator implant procedure has been considered, but is not given a high chance of a long-term success. The doctors agree that he is restricted from repetitive bending, lifting, climbing, walking, and sitting for long periods.

The Plaintiff was referred to Dr. Donald Richardson, a neurosurgeon, by Dr. Hugh Fleming, a neurologist. He examined the Plaintiff on October 30, 1998, March 22, 1999, and October 18, 1999. He concluded that the implant surgery might be helpful. However, he recommended a chronic pain work up, which includes psychological testing and evaluation, detoxification and group sessions, before offering the Plaintiff the implant procedure because the Plaintiff might not be a good candidate due to his depression. At any rate, the recovery period for this surgery was only six to twelve weeks. He also disagreed with a recommendation by Dr. Barbara Smith for the use of electro-cuticle heat. He felt that both electro-cuticle heat and the injections given by Dr. Harry Philibert were useless.

Dr. Richardson concluded that the Plaintiff can perform light sedentary work, with no repeated bending, standing, lifting, and which allows him to alternate standing and sitting. Although he agreed that Plaintiff could perform inside telephone sales, he thought that the Plaintiff cannot go out of the house to work. Dr. Richardson further felt that it is unrealistic to expect this patient to successfully hold a job, based on his experience with patients with this level of chronic pain.

Dr. Mimeles, the independent medical examiner (IME), examined the Plaintiff on January 26, 1999 and again in May of 1999. Like Dr. Richardson, he thought that the injections of cortisone being given to the Plaintiff should be stopped. He noted that the Plaintiff was receiving up to 30 per week and cortisone has long-term side effects. He agreed that the Plaintiff has chronic pain from permanent and irreversible nerve root irritation and has reached MMI. Although he stated that the Plaintiff needs to move around, Dr. Mimeles testified that the Plaintiff can only perform minimal sedentary work, with the restrictions noted by Dr. Richardson. Dr. Mimeles stated that the Plaintiff should attempt one of the jobs found for him, but if he is unable to continue working, then he should have a functional capacity evaluation.

Numerous medical reports were introduced into evidence. Those show that, Dr. Robert Applebaum, a neurosurgeon, examined the Plaintiff in 1998.

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Bluebook (online)
821 So. 2d 52, 2001 La.App. 5 Cir. 1393, 2002 La. App. LEXIS 1419, 2002 WL 992184, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kaiser-v-western-southern-ins-co-lactapp-2002.