Mary Ortega v. Cantu Services, Inc.

CourtLouisiana Court of Appeal
DecidedOctober 23, 2019
DocketWCA-0019-0202
StatusUnknown

This text of Mary Ortega v. Cantu Services, Inc. (Mary Ortega v. Cantu 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
Mary Ortega v. Cantu Services, Inc., (La. Ct. App. 2019).

Opinion

STATE OF LOUISIANA COURT OF APPEAL, THIRD CIRCUIT 19-202

MARY ORTEGA Plaintiff-Appellant

VERSUS

CANTU SERVICES, INC. AND LIBERTY MUTUAL INSURANCE CO. Defendants-Appellees

********** ON APPEAL FROM THE OFFICE OF WORKERS’ COMPENSATION DISTRICT 2 DOCKET NO. 18-01006 RAPIDES PARISH JAMES BRADOCK, WORKERS’ COMPENSATION JUDGE

**********

JONATHAN W. PERRY JUDGE

Court composed of John D. Saunders, Phyllis M. Keaty, and Jonathan W. Perry, Judges.

REVERSED, IN PART, AND AFFIRMED AS AMENDED. George A. Flournoy Flournoy Law Firm 1239 Jackson Street Alexandria, Louisiana 71301 Phone (318) 487-9858 Counsel for Appellant: Mary Ortega

Gregory J. Laborde Daigle Rayburn LLC 303 W. Vermilion, Suite 210 P. O. Box 3667 Lafayette, Louisiana 70502 Phone (337) 234-7000 Counsel for Appellees: Cantu Services, Inc. and Liberty Mutual Insurance Co. PERRY, Judge. In this workers’ compensation case, Mary Ortega (“Ortega”) appeals the

judgments of the Office of Workers’ Compensation, denying her motion to enforce

a settlement agreement, the denial of her request that she be found permanently and

totally disabled, the attendant issues of the adequacy of the penalties, attorney fees,

and the assessment of costs. We reverse in part and affirm as amended.

FACTS AND PROCEDURAL HISTORY

Ortega, an employee of Cantu Services, Inc. (“Cantu”), was injured on the job

at Fort Polk on February 23, 2011. At the time of the accident, Ortega was pulling

mermites1 to heat and then take to the soldiers in the field. As she was pulling the

mermites, she fell backwards striking her neck and back on a crate; as a result of her

fall, she injured her right arm, and experienced low-back and neck pain. After being

treated at the Natchitoches Hospital, Ortega was seen by Dr. Robert K. Rush (“Dr.

Rush”), an injury management specialist, who treated her conservatively with

medication and physical therapy. She also received like conservative treatment from

Dr. George R. Williams (“Dr. Williams”), an orthopaedic surgeon in Opelousas,

even though at one point he recommended a two-level anterior cervical fusion.

Eventually, Dr. Rush referred her to Dr. J. David Delapp (“Dr. Delapp”) who

performed rotator cuff surgery on Ortega’s right shoulder. Liberty Mutual Insurance

Company (“Liberty Mutual”), Cantu’s workmen’s compensation carrier, approved

all of Ortega’s medical treatment, and began paying an appropriate sum of weekly

workers’ compensation benefits to Ortega.2

On March 11, 2013, Ortega was involved in a motor vehicle accident

unrelated to her employment. She consulted Dr. Clark A. Gunderson (“Dr.

1 In the military, mermites are insulated containers used to keep hot food warm in the field.

2 Although it was never awarded by a court, Liberty Mutual voluntarily paid Ortega temporary total disability benefits. Gunderson”), an orthopaedic surgeon, for injuries she sustained in the accident,

which included her claim that the accident exacerbated her work-related injuries.

Dr. Gunderson performed various diagnostic tests and determined that Ortega

needed surgery to correct problems she was having in her neck. On September 9,

2013, Dr. Gunderson successfully performed a two-level anterior cervical

discectomy and fusion at C3-4 and C4-5.3

On June 27, 2014, Ortega filed a Disputed Claim for Workers’ Compensation

against Cantu and Liberty Mutual (“Defendants”). In 2016, Ortega and Defendants

reached a settlement which was judicially approved and recited in open court on

September 1, 2016. In Ortega v. Cantu Services, Inc., 17-1123, p. 1 (La.App. 3 Cir.

5/2/18), 246 So.3d 827, 828-29,4 we referenced and recited the settlement:

The agreement was explained on the record by counsel for Cantu and its insurer, Liberty Mutual Insurance Company, as follows: Mr. Laborde: Your Honor, we’ve agreed to compromise all claims asserted by Ms. Ortega in each docket number for the total sum of $120,000.

3 Based upon answers to interrogatories, it appears Ortega settled her third-party claim for this rear-end accident on September 17, 2015, against Terry Weaver, Phillips Distributing, LLC, and Progressive Gulf Insurance Company, Hanover Insurance Group and/or Allmerica Financial Benefit Insurance Company.

4 In that opinion we upheld the WCJ’s decision to deny Ortega’s Motion to Enforce Settlement and for penalties and attorney fees after concluding the settlement was conditioned on CMS approval of a Medicare Set-Aside Agreement. We also struck the following language in Cantu’s brief:

Appellees [Cantu] submitted a request to the Center for Medicare Services for approval of the negotiated Medicare Set Aside Agreement, submitting the appropriate medical records and information. However, the request for approval was denied by CMS. Appellant [Ortega] was informed of the denial and provided with the reasons for denial and informed of what additional information was needed from Appellant and Appellees in order to address the concerns of CMS regarding the sufficiency of the Medicare Set Aside Agreement. To date, Appellant has not furnished to Appellees any of the requested information. ... Appellant has been advised of the reasons for the denial of the Medicare Set Aside Agreement and has yet to furnish to Appellees any of the information needed in order to respond to the objections of CMS.

Ortega at 829–30.

2 We will file with CMS [Centers for Medicare and Medicaid Services] approval for a Medicare set-aside agreement [MSA] in the amount of $56,049. The balance that would then be paid in benefits is $63,951. Now, the proviso is if CMS does not approve the requested amount, but alters it in any way, we will fund the MSA as directed by CMS and then adjust the amount to be paid in benefits accordingly, so that the total of the settlement still amounts to $120,000. And we will continue to pay benefits until we get the CMS approval and the funds tendered to claimant. Mr. Flournoy [counsel for Ms. Ortega]: .... Yeah, that’s right. Judge Braddock: And you understand the nature of this compromise, Ms. Ortega?

....

Ms. Ortega: Yes, sir.

In accordance with that workers’ compensation settlement agreement,

Defendants continued weekly temporary total disability benefits until January 25,

2018. Subsequent to the discontinuation of weekly benefits, Ortega filed a Disputed

Claim for Compensation on February 16, 2018, for Defendants’ non-payment of

temporary total disability benefits and medical benefits, and further sought penalties,

attorney fees, interest, and court costs. Thereafter, on September 5, 2018, Ortega

also filed a Motion to Enforce Settlement of 2016, in which she sought to have

Defendants resume payment of the weekly indemnity benefits, effective January 25,

2018, and to continue those indemnity benefits until Defendants obtain CMS

approval of a MSA.

After conducting a hearing on October 8, 2018, the Workers’ Compensation

Judge (“WCJ”) denied Ortega’s Motion to Enforce Settlement. A judgment to that

effect was signed on October 15, 2018. On October 24, 2018, Ortega filed a motion

for new trial on the denial of the motion to enforce settlement. On November 26,

2018, the WCJ denied Ortega’s motion for new trial.

A hearing with witnesses was held on October 18, 2018, on the issues Ortega

raised in her Disputed Claim for Compensation. After taking the matter under

advisement, the WCJ (1) denied Ortega’s claim for permanent total disability 3 benefits; (2) found Ortega’s claims for medical benefits prescribed;5 (3) found

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Smith v. Two" R" Drilling Co., Inc.
606 So. 2d 804 (Louisiana Court of Appeal, 1992)
Day v. Campbell-Grosjean Roofing & Sheet Metal Corp.
256 So. 2d 105 (Supreme Court of Louisiana, 1971)
Britton v. City of Natchitoches
707 So. 2d 142 (Louisiana Court of Appeal, 1998)
McCarroll v. Airport Shuttle, Inc.
773 So. 2d 694 (Supreme Court of Louisiana, 2000)
Brown v. Texas-LA Cartage, Inc.
721 So. 2d 885 (Supreme Court of Louisiana, 1998)
Sharbono v. Steve Lang & Son Loggers
696 So. 2d 1382 (Supreme Court of Louisiana, 1997)
Petition of Sewerage & Water Board of New Orleans
278 So. 2d 81 (Supreme Court of Louisiana, 1973)
Williams v. Rush Masonry, Inc.
737 So. 2d 41 (Supreme Court of Louisiana, 1999)
Hood v. CJ Rogers, Inc.
654 So. 2d 371 (Louisiana Court of Appeal, 1995)
Redler v. Giorlando's Restaurant Corp.
979 So. 2d 512 (Louisiana Court of Appeal, 2008)
Cain v. Employers Casualty Company
110 So. 2d 108 (Supreme Court of Louisiana, 1959)
Arceneaux v. Amstar Corp.
66 So. 3d 438 (Supreme Court of Louisiana, 2011)
Harris v. City of Bastrop
161 So. 3d 948 (Louisiana Court of Appeal, 2015)
Turner v. Lexington House
176 So. 3d 1071 (Louisiana Court of Appeal, 2015)
Sanctuary Capital, LLC ex rel. North Louisiana Bidco, LLC v. Cloud
176 So. 3d 405 (Supreme Court of Louisiana, 2015)
Williamson v. Liberty Mutual Insurance
92 So. 3d 1218 (Louisiana Court of Appeal, 2012)
Thibodaux v. Grand Isle Shipyard, Inc.
207 So. 3d 459 (Louisiana Court of Appeal, 2016)
Ferry v. Holmes & Barnes, Ltd.
124 So. 848 (Louisiana Court of Appeal, 1929)
Day v. Allen
129 So. 260 (Louisiana Court of Appeal, 1930)
Ortega v. Cantu Servs., Inc.
246 So. 3d 827 (Louisiana Court of Appeal, 2018)

Cite This Page — Counsel Stack

Bluebook (online)
Mary Ortega v. Cantu Services, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/mary-ortega-v-cantu-services-inc-lactapp-2019.