Manuel v. River Parish Disposal, Inc.

683 So. 2d 791, 1996 WL 556947
CourtLouisiana Court of Appeal
DecidedOctober 1, 1996
Docket96-CA-302, 96-CA-303
StatusPublished
Cited by17 cases

This text of 683 So. 2d 791 (Manuel v. River Parish Disposal, 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
Manuel v. River Parish Disposal, Inc., 683 So. 2d 791, 1996 WL 556947 (La. Ct. App. 1996).

Opinion

683 So.2d 791 (1996)

Matthew J. MANUEL
v.
RIVER PARISH DISPOSAL, INC. and Guarantee Mutual Life Insurance Company.

Nos. 96-CA-302, 96-CA-303.

Court of Appeal of Louisiana, Fifth Circuit.

October 1, 1996.

*792 Patrick J. Berrigan, Rodney J. Lacoste, Jr., Slidell, for Appellants Jefferson Parish Hospital Service District No. 2 d/b/a East Jefferson General Hospital and Matthew J. Manuel.

Edgar K. Corey, New Orleans, for Appellees River Parish Disposal Inc. and Guarantee Mutual Life Insurance Company.

Before GOTHARD, CANNELLA and DALEY, JJ.

CANNELLA, Judge.

In a worker's compensation case, plaintiffs, Matthew Manuel (Manuel) and East Jefferson General Hospital (EJGH), appeal from an award of medical expenses and attorney fees. Defendants are Manuel's employer, River Parish Disposal, Inc. (RPD), and its insurer, Guarantee Mutual Life Insurance Company (Guarantee). We reverse the judgment which grants defendants' exception of prescription and amend to increase the medical expenses, award penalties, increase the attorney's fees and reassess legal interest.

On August 1, 1991 Manuel was injured in the course and scope of his employment when the garbage truck which he was driving left the roadway and crashed into a drainage ditch. Immediately before the crash, Manuel jumped from the truck. He suffered head injuries and was admitted to the Intensive Care Unit of EJGH. Manuel was then taken to surgery, where a subarachnoid screw was placed in his right frontal lobe to relieve the pressure caused by a contusion on his brain. While in Intensive Care, the pressure on his *793 brain was controlled with mechanical ventilation, diuretics, steroids, anticonvulsant and chemical paralysis. Ultimately, the pressure was controlled, the screw removed and he was weaned from the ventilator. He was discharged from EJGH on August 16, 1991.

On August 2, 1991, plaintiff's employer, RPD, was contacted by EJGH regarding their responsibility for payment. RPD's representative, Lisa Mink (Mink), informed EJGH that the claim would be paid as a workers' compensation claim. However, on August 14, 1991, Mink informed EJGH that the claim was not going to be paid because lab tests showed that Manuel had a controlled substance in his system. A letter confirming the denial of the medical expenses was received from Mink to that effect on August 19, 1991. Nonetheless, the hospital forwarded a bill to RPD on October 3, 1991 in the amount of $65,653.44 for services to Manuel during his hospitalization. When no payments were received from RPD, on February 21, 1992 EJGH filed a Request For Review of Physician's Fees (form 1016) with the Office of Workers' Compensation Administration (OWC). On August 3, 1992, Manuel filed a Disputed Claim for Compensation (form 1008) with the OWC. Defendants continued to deny the claims for both compensation and medical expenses because of the drug test results.

On April 26, 1993, Neurosurgical Associates/William J. Johnston, Jr., M.D., plaintiff's surgeon, and Parish Anesthesia/Joseph Spalitta, M.D., his anesthesiologist, filed a Request For Review of Physician's Fees with the OWC. RPD responded that the claims were being denied on the basis of intoxication and Manuel's wilful intent to injure himself.

On January 24, 1994, defendants filed an Exception of Prescription to the claims of Dr. Johnston, Jr. and Dr. Spalitta. On January 28, 1994, EJGH and Manuel filed a First Supplemental and Amended Petition to (1) recognize Manuel as a plaintiff in the EJGH claim to the extent that he was not already a plaintiff; (2) request as damages any and all amounts due Drs. Johnston and Spalitta; (3) request penalties, attorney's fees and court costs for RPD's continued arbitrary and capricious refusal to pay for the medical services and treatment provided Manuel. A minute entry on January 28, 1994 indicates that the hearing officer granted the exception of prescription as to the claims of the doctors, but the record does not contain a judgment.

On June 2, 1994, defendants filed an amended answer to EJGH's claim, alleging that the claim was denied because the charges were unreasonable and in excess of the OWC fee schedule, that Manuel was intoxicated under La.R.S. 23:1081(5), and that neither the charges nor the reasonableness of the medical care was submitted for utilization review. On the same date, defendants also filed an amended answer to Manuel's initial claim for compensation, asserting that, at the time of the accident, Manuel was intoxicated and willfully intended to injure himself.

On September 29, 1994, Manuel filed a Second Supplemental and Amended Petition to his Form No. 1008 compensation claim, requesting that RPD be held responsible for any and all medical expenses incurred as a result of the accident, including those owed to Drs. Johnston and Spalitta, along with penalties, attorney's fees and court costs because of RPD's continued arbitrary and capricious refusal to pay the medical expenses.

On November 16, 1994, defendants filed a supplemental answer denying the claims, further asserting that the claims for medical expenses owed to Drs. Johnston and Spallita were prescribed and had already been declared prescribed by the hearing officer and that, through Manuel, the doctors were attempting to do indirectly what they could not do directly. Defendants also contended further that Manuel was not entitled to the medical expenses for the doctors because the doctors' claims against Manuel were prescribed under the three year prescriptive period for open accounts.

On May 5, 1995, Guarantee deposited with the court the sum of $26,835, asserting that this was the amount due EJGH pursuant to the OWC reimbursement fee schedule that was promulgated and which went into effect after Manuel's accident.

*794 The trial of the claims was held on May 11, 1995. Immediately before trial, Manuel settled his claim for compensation benefits, but he reserved his rights for recovery of his medical expenses. On June 5, 1995, the hearing officer rendered a judgment in favor of plaintiffs in the sum of $46,260, including the deposited sum of $26,835, plus $6,206.25 in judicial interest from June 1, 1993 through the date of the judgment, June 5, 1995. In addition, the hearing officer found that defendants were arbitrary and capricious in failing to pay the reasonable amount of medical expenses and awarded EJGH $3,000 in attorney's fees. Finally, the hearing officer granted the exception of prescription filed by RPD relative to the claims by Drs. Johnston and Spalitta. On September 15, 1995, an additional sum of $31,267.25 was deposited into the registry of the court raising the total deposited to the total amount of the judgment, $58,102.25.

On appeal, plaintiffs first contest the amount awarded for the medical services provided by EJGH and second argue that the claim for the bills submitted by Drs. Johnston and Spalitta were not prescribed. Third, plaintiffs assert that the hearing officer erred in failing to award statutory penalties. Fourth, they contend that the award for attorney's fees was an abuse of discretion. Fifth, plaintiffs assert that the hearing officer erred in accepting Don Long as an expert in determining the reasonableness of hospital charges. Sixth, plaintiffs assert that the hearing officer erred in his calculation of judicial interest.

EJGH'S MEDICAL EXPENSES & EXPERT TESTIMONY OF DON LONG

Plaintiffs assert that the hearing officer erred in discounting by 30% the principal amount owed to EJGH for the services and treatment rendered to plaintiff during his hospitalization.

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Cite This Page — Counsel Stack

Bluebook (online)
683 So. 2d 791, 1996 WL 556947, Counsel Stack Legal Research, https://law.counselstack.com/opinion/manuel-v-river-parish-disposal-inc-lactapp-1996.