Mary Ortega v. Cantu Services, Inc.

Louisiana Court of Appeal·Decided October 23, 2019·No. WCA-0019-0202·Unknown

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.

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.

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