LeJeune v. Trend Services, Inc.

699 So. 2d 95
CourtLouisiana Court of Appeal
DecidedSeptember 30, 1997
Docket96-550
StatusPublished
Cited by21 cases

This text of 699 So. 2d 95 (LeJeune v. Trend Services, 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
LeJeune v. Trend Services, Inc., 699 So. 2d 95 (La. Ct. App. 1997).

Opinion

699 So.2d 95 (1997)

Ernie LeJEUNE, Plaintiff—Appellant,
v.
TREND SERVICES, INC., et al., Defendants—Appellees.

No. 96-550.

Court of Appeal of Louisiana, Third Circuit.

June 4, 1997.
Order Granting Rehearing September 30, 1997.

*97 Michael Benny Miller, Crowley, for Ernie LeJeune.

David Keith Johnson, Baton Rouge, for Trend Services, Inc.

Before WOODARD, DECUIR, PETERS, AMY and GREMILLION, JJ.

PETERS, Judge.

Ernie LeJeune brought this action to recover certain benefits pursuant to the Louisiana Workers' Compensation Act. Named as defendants were his employer, Trend Services, Inc., and its compensation insurer, Louisiana Workers' Compensation Corporation (LWCC). At trial, LeJeune sought authorization of physical therapy treatments recommended by one of the treating physicians as well as statutory penalties and attorney fees for the insurer's failure to authorize the physical therapy; for its failure to timely authorize an MRI and surgery for carpal tunnel syndrome as recommended by one of the treating physicians; for its failure to timely pay compensation benefits and medical expenses; and for its policy of requiring insurance reimbursement for the cost of generic drugs only, unless otherwise directed by the physician writing the prescription.

After trial, the hearing officer issued written reasons for judgment wherein she concluded that the requested physical therapy, MRI, and carpal tunnel surgery were all reasonable and necessary medical treatments or procedures which should have been timely approved by LWCC. She further found that LWCC was arbitrary and capricious in failing to timely authorize these treatments or procedures and in failing to timely pay certain medical costs. Based on these findings, she awarded LeJeune statutory penalties not to exceed $2,000.00 and attorney fees of $2,500.00.

Although the hearing officer concluded that every weekly payment was mailed the day after the due date, her reasons for judgment are silent as to any award for this action on the part of the insurer. She also found no statutory violation for the insurer's requirement that LeJeune use only generic drugs. LeJeune has appealed, asserting six assignments of error.

DISCUSSION OF THE RECORD

At trial, it was stipulated that on April 13, 1993, Ernie LeJeune sustained back and neck injuries as a result of an accident which occurred while he was in the course and scope of his employment with Trend Services, Inc. It was further stipulated that LeJeune was entitled to temporary total benefits and that he had been paid such benefits at the rate of $307.00 per week since the accident but that each weekly payment was mailed one day late.

LeJeune was seen by Dr. Michael Heard, an orthopedic surgeon, who concluded that LeJeune had suffered a soft tissue injury and recommended surgery for carpal tunnel syndrome. The recommendation was made in March, 1994. The insurer obtained a second opinion from Dr. Louis Blanda, also an orthopedic surgeon. Dr. Blanda concurred in the need for surgery, but the surgery was not approved by the insurer until November, 1994, or almost eight months after the initial recommendation.

In February, 1995, Dr. Heard recommended that an MRI be performed on LeJeune. The insurer submitted the recommendation to a utilization review company, which concluded that the MRI was not necessary. The insurer again consulted with Dr. Blanda, who concurred in the need for the *98 MRI. Still, the insurer did not approve the MRI until late June or early July, 1995.

Dr. Heard had also recommended on April 13, 1995, that LeJeune take physical therapy treatments, but after submitting that recommendation to utilization review, it was also denied. These treatments had not been approved at the time of trial.

The trial before the hearing officer was held on October 19, 1995, and judgment was rendered with written reasons on March 15, 1996. LeJeune has appealed this judgment, seeking additional relief. Specifically, LeJeune contends that the hearing officer erred in failing to:

1. find that LeJeune was entitled to weekly compensation benefits;
2. find that the insurer did not pay weekly compensation benefits timely;
3. find that the insurer withheld medical treatment by refusing to allow LeJeune to fill his prescriptions as written;
4. find that the insurer did not pay Dr. Heard's medical charges timely;
5. assess the exact amount of penalties due LeJeune.
6. award reasonable attorney fees.

OPINION

The factual findings of a hearing officer in a workers' compensation case are subject to the manifest error standard of review, and where there is a conflict in the testimony, reasonable inferences of fact should not be disturbed on review. Joiner v. Newberg Venture, 94-1533 (La.App. 3 Cir. 5/3/95); 657 So.2d 206. Furthermore, absent manifest error, the hearing officer's determination concerning an award of penalties and attorney fees will not be disturbed on appeal. Miles v. F.D. Shay Contractor, Inc., 626 So.2d 74 (La.App. 3 Cir.1993).

In his first assignment of error, LeJeune contends that the hearing officer erred in failing to find that he was entitled to weekly compensation benefits. Although the judgment is silent as to LeJeune's right to be paid weekly benefits, it was stipulated at trial that he was injured and entitled to temporary total disability benefits at the rate of $307.00 per week and that the insurer continues to pay these benefits on a weekly basis. Because there is no dispute concerning the payment of benefits, the hearing officer did not err in failing to include this finding in her reasons for judgment.

LeJeune's second assignment of error, i.e., that the hearing officer erred in not finding that the defendant failed to pay weekly workers' compensation benefits timely, was withdrawn at oral argument. Therefore, we will consider it abandoned.

The third assignment of error deals with the insurer's refusal to allow LeJeune to fill his prescriptions as written. The insurer has a "managed prescription drug program" which pays only the cost of a less expensive generic drug when such is available, despite what the prescription calls for. If the employee chooses the more expensive brandname drug, he must pay the difference in price. However, the program does not apply to medications prescribed with a physician's designation "Dispense as Written." Moreover, should the patient or pharmacist believe that the brand-name drag is required, the patient or pharmacist may contact the prescribing physician and request that the prescription be revised as a "Dispense as Written" prescription. LeJeune argues that there is no statutory authority or jurisprudence that allows the insurer to substitute generic drugs for brand-name drugs without the employee's consent and that such a substitution constitutes withholding of medical treatment.

The problem with the insurer's program is that it presumes that the doctor, patient, and pharmacist are well-informed about their choices and that they are well-informed about the insurer's willingness to pay for brand-name drugs under the appropriate circumstances. Additionally, the program places the duty on either the doctor, the pharmacist, or the patient, or all three, to adhere to the internal policy, for which there is no legal authority and which was created solely to serve the best interests of the insurer—not the employee.

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Bluebook (online)
699 So. 2d 95, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lejeune-v-trend-services-inc-lactapp-1997.