Lanclos v. Coastal Food, LLC.

877 So. 2d 309, 4 La.App. 3 Cir. 222, 2004 La. App. LEXIS 1783, 2004 WL 1496645
CourtLouisiana Court of Appeal
DecidedJuly 7, 2004
DocketNo. 04-222
StatusPublished
Cited by2 cases

This text of 877 So. 2d 309 (Lanclos v. Coastal Food, LLC.) 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
Lanclos v. Coastal Food, LLC., 877 So. 2d 309, 4 La.App. 3 Cir. 222, 2004 La. App. LEXIS 1783, 2004 WL 1496645 (La. Ct. App. 2004).

Opinion

hAMY, Judge.

In this workers’ compensation matter, the employee-claimant contested the termination of his indemnity benefits and also sought attorney’s fees and penalties, alleging that the employer had improperly calculated his average weekly wage and the corresponding weekly indemnification rate; had untimely paid weekly indemnity and medical benefits; had untimely approved medical benefits; had failed to approve his choice of physician; and had failed to timely provide a copy of a second medical opinion examination performed at the employer’s request. The employer, in turn, argued that the employee’s benefits were terminated because he failed to truthfully disclose a prior neck injury, thereby committing fraud. After a hearing, the workers’ compensation judge ruled in favor of the employee. The employer’s workers’ compensation insurer appeals. For the following reasons, we affirm the ruling as amended.

Factual and Procedural Background

The record indicates that during the early morning hours of February 21, 2001, Ronald Landos (hereinafter “Mr. Landos” or “the claimant”), a delivery driver for Coastal Food, L.L.C., was working at a dock in Cameron, Louisiana, loading groceries into a metal container for transport offshore. At the disputed-claim hearing in the matter, Mr. Landos testified that this particular container previously held used cooking oil that had been shipped back to land from offshore, and some of this oil had leaked onto the container’s floor. Mr. Landos recalled that when he had filled the container between one-half and three-quarters full, he slipped on the cooking oil and struck the side of the container’s metal doorframe from the center of his back to the back of his neck. He testified that because the injury occurred in the early morning hours, there was no one at Coastal’s office to whom he could report the injury, but 1 ¡.after the office opened in the morning, he spoke with office personnel and came in to file an accident report.

Mr. Landos testified that when it was apparent that his injury would not resolve itself, he went to the emergency room at Opelousas General Hospital. The record reflects that during this initial visit to [312]*312Opelousas General, a CT scan was performed, and the results showed injuries to Mr. Landos’ spine. Accordingly, the emergency-room physician referred him to Dr. Morgan Lorio, an orthopedist, for further treatment. Dr. Lorio, in turn, ordered an MRI, which also indicated spinal injuries. However, the record reflects that Mr. Landos’ treatment with Dr. Lorio ceased when Dr. Lorio closed his practice in Louisiana and moved to Tennessee. Accordingly, Mr. Landos contacted his employer’s workers’ compensation insurer, Louisiana Restaurant Association Self Insurers Fund (“LRASIF”), and requested approval to consult Dr. Michel Heard, an orthopedist, for further treatment. Dr. Heard subsequently recommended that the claimant consult Dr. Alan Appley, a neurosurgeon. Mr. Landos asserted at the disputed-claim hearing that Coastal Food and LRASIF never approved treatment with Dr. Heard and never paid any of the associated costs incurred; in addition, he pointed out, Coastal Food and LRASIF never paid any of his medical expenses. Moreover, the claimant noted that as of the time of hearing, an MRI requested by Dr. Heard had not been approved.

Mr. Landos filed the initial disputed claim on February 21, 2002, in which he complained that his wage benefits had been terminated or reduced on or around March 5, 2001. In his first amendment to the disputed claim, filed March 26, 2003, Mr. Landos asserted that Coastal Food and LRASIF had improperly calculated his average weekly wage and his weekly indemnification rate; that they had untimely |spaid weekly indemnity benefits; that they had untimely approved and untimely paid medical benefits; and that they had failed to approve the claimant’s choice of physician in the field of orthopedics, Dr. Michel Heard. Moreover, in his pre-trial statement, Mr. Landos requested attorney’s fees and penalties for arbitrary and capricious conduct. In yet another amendment to the original disputed claim filed before the hearing, Mr. Landos insisted that Coastal Food and LRASIF did not timely provide him a copy of a second medical opinion report and sought penalties and attorney’s fees accordingly. In the meantime, Coastal Food and LRASIF filed a disputed-claim form on August 13, 2001, in which they explained that the claimant’s benefits were suspended due to his not having accepted light-duty work offered by Coastal Food and for failing to truthfully inform Coastal of his prior medical condition.1

[313]*313The instant claim was heard by a workers’ compensation judge on November 7, 2003. During the proceedings, Newton Thomas, the insurance adjuster assigned to the case, testified that Mr. Landos’ benefits were terminated based upon what he 14perceived to be fraudulent conduct on Mr. Landos’ part. Mr. Thomas stated that he was suspicious of Mr. Landos’ claims owing to inconsistencies in the manner in which he described the accident to his superiors at Coastal. Mr. Thomas further indicated that he decided to terminate the claimant’s benefits under La.R.S. 23:1208.1 in consideration of the following factors: (1) the claimant had not disclosed prior medical history on his post-hire questionnaire; (2) he had not told the truth and failed to mention his prior neck problem during his recorded statement; (3) he told Drs. Morgan Lorio and Greg Gidman about his prior neck injury but did not tell Mr. Thomas; and (4) certain information found in the records of Dr. Thomas Ber-tuccini, who treated the claimant for an injury sustained in 1994. Mr. Thomas pointed out that the claimant’s prior medical history, as outlined by Drs. Lorio and Gidman, reflected that the claimant had complained of neck pain before the accident at issue. Mr. Thomas further explained that the claimant’s prior neck injury had been documented as a herniated cervical disc and that this was confirmed by MRI. He noted that after Mr. Landos told him that he had hit his neck and shoulder in a previous accident, during the recorded statement taken by phone on February 23, 2001, he did not ask specific questions about his neck; however, he said that when he asked the claimant what kind of treatment was provided, this was the claimant’s opportunity to explain his injury, his “chance to take the ball and run with it.” However, the claimant did not provide further information.

Mr. Landos testified at the hearing in the matter that he was involved in an accident in 1994 while working offshore for ENSCO Marine, explaining that he hit a constavolt box with his shoulder when he was trying to change a fly wheel on a generator on board a ship. The claimant indicated that he filled out an accident report |sbut did not consult a physician until a fire aboard the ship resulted in a lull in his employment. He recalled that upon seeking medical attention, the injury was “worse than [he initially] thought,” and his treating physician referred him to Dr. Thomas Bertuccini, a Lafayette neurosurgeon. At the hearing below, the claimant maintained that Dr. Bertuccini did not tell him that something was wrong with his neck but merely referred him to Dr. Robert Franklin, a physical medicine and rehabilitation specialist. Dr. Franklin’ in turn, ordered a myelogram and a post-CT scan, both of which Mr. Landos described as “negative.” The claimant was then released from physicians’ care.

During the proceedings below, Mr.

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Bluebook (online)
877 So. 2d 309, 4 La.App. 3 Cir. 222, 2004 La. App. LEXIS 1783, 2004 WL 1496645, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lanclos-v-coastal-food-llc-lactapp-2004.