McCombs v. G.L. Jones Construction, Inc.

161 So. 3d 976, 2015 La. App. LEXIS 44, 2015 WL 160649
CourtLouisiana Court of Appeal
DecidedJanuary 14, 2015
DocketNo. 49,541-WCA
StatusPublished

This text of 161 So. 3d 976 (McCombs v. G.L. Jones Construction, 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
McCombs v. G.L. Jones Construction, Inc., 161 So. 3d 976, 2015 La. App. LEXIS 44, 2015 WL 160649 (La. Ct. App. 2015).

Opinion

PITMAN, J.

_JjThis appeal arises from a judgment of the Workers’ Compensation Judge (“WCJ”) on a claim for indemnity and medical benefits under the Louisiana Workers’ Compensation Act (“LWCA”) brought by Claimant Damon S. McCombs, [978]*978who injured his right foot while working for G.L. Jones Construction, Inc. (“Jones Construction”). Jones Construction and its insurer, Valley Forge Insurance Company, (collectively, “Defendants”) appeal that portion of the judgment awarding Claimant statutory penalties and attorney fees. For the following reasons, we reverse the judgment of the WCJ.

FACTS

On April 12, 2012, Claimant, who is from Alabama, was a welding supervisor for Jones Construction, an Alabama corporation, on a job at the International Paper mill in Mansfield, Louisiana. As he was watching someone weld in front of him, a piece of steel under high pressure shot out and hit the top of Claimant’s right foot. He received emergency treatment in Shreveport and followed up the next day at the Work Place at Highland Clinic. He was still in pain and decided to return to Alabama for further treatment.

Shortly after the accident, Claimant discussed the accident and his injury with Gary Jones of Jones Construction. In order to avoid a “lost-time” claim, Mr. Jones terminated Claimant and told him to return to Alabama to claim unemployment.1 He agreed to help pay for medical | ^treatment if Claimant did not make a lost time claim. Claimant agreed. Mr. Jones arranged for someone to drive Claimant to Alabama, and an appointment was made for him to see a “Dr. May.” However, that appointment was cancelled. On referral from Mr. Jones, Claimant saw a podiatrist, Dr. David Borcicky, on April 18, 2012. Jones Construction faxed a letter to Dr. Borcicky authorizing treatment up to $500. The letter indicated that Claimant’s injury was relatively minor and concluded that, if it turned out to be more substantial, the company would determine whether to submit the claim to its workers’ compensation insurer.

Dr. Borcicky confirmed the diagnosis of a large contusion, with associated swelling, on the top of Claimant’s foot. He continued to treat Claimant for several weeks (nine visits). Although the abrasion and swelling gradually improved, Claimant continued to complain of pain with activity. Dr. Borcicky last saw Claimant on June 6, 2012. Although he advised Claimant to return to see him, Claimant did not return and did not receive any further treatment on his foot by any physician. The reason for lack of further treatment was not clear.

Claimant, through an attorney, filed a disputed claim for compensation, LDOL-WC-1008, on March 18, 2013. He asserted that no wage or medical benefits had been paid. None of the other boxes on the form were checked even though box number 6 states, “Medical treatment (Procedure/Prescription) _ recommended by _not authorized.” There is also a box which can be checked which states, “Choice of physician |s(specialty)_” There is no box on the form to check showing what relief Claimant expected. Under “Other,” Claimant alleged:

Employee was injured and then terminated when he reported the injury. He initially filed for worker’s compensation benefits in his state of residence (AL) and the state in which he was hired by [979]*979contract (AL). Such case has been dismissed due to lack of subject matter jurisdiction in AL.

The form contains the following instruction:

You may attach a letter or petition with additional information with this disputed claim or when later amending this disputed claim (Form LDOL-WC-1008). You must provide a copy of this claim and any amendment to all opposing parties.2

At the hearing on his petition, in explaining why he received no further medical attention for his injury after Dr. Bor-cicky last saw him, Claimant testified that the termination of medical treatment coincided with his retention of an attorney who wanted him to see a different physician. There was no evidence, however, that he or his lawyer submitted such a request to Jones Construction or that any such request had been denied. Claimant testified that his attorney informed him that he would discuss the new physician with Jones Construction, but, “like, all communication with G.L. Jones and Cindy Jones kind of quit happening. We didn’t communicate any more.”

The WCJ’s judgment identified four questions: 1) whether Claimant was entitled to further medical treatment; 2) whether Claimant was entitled to indemnity benefits; 8) whether Claimant forfeited any claim pursuant to |4La. R.S. 23:1208;3 and 4) whether Claimant was entitled to penalties and attorney fees under La. R.S. 23:1201.

The WCJ determined that Defendants had paid for all treatment provided to Claimant to date, but had failed to provide all of the treatment to which he was entitled by law. He found that Claimant did not choose any of his treating physicians, noting that the doctors in Shreveport were seen on an emergency basis and Dr. Bor-cicky was chosen by Jones Construction. He further found that, while the reason for the termination of treatment was not clear, Defendants became aware that Claimant was demanding additional medical treatment when he filed his disputed claim; nevertheless, they denied any responsibility for further care. Based on the evidence, the WCJ found that Defendants denied Claimant the right to treatment with a physician of his choice and ordered them to approve such treatment in accordance with La. R.S. 23:1203.1 and the workers’ compensation fee schedule.

The WCJ denied Claimant permanent and total disability benefits since he was receiving unemployment compensation benefits during a period for which he was claiming entitlement to indemnity benefits. He also found that Claimant had failed to show he was actually totally disabled, permanently or otherwise.

The WCJ’s judgment stated that Claimant’s pleadings did not include a demand for statutory penalties and attorney fees, but noted that Louisiana |scourts have recognized a duty to “ferret out” such claims in appropriate circumstances. The WCJ found such circumstances in this case and noted that La. R.S. 23:1201(F) provides for penalties and attorney fees [980]*980where the employer or its insurer fails to reasonably controvert a claim for benefits. He further found that unreasonably' controverting a claim requires action of a less egregious nature than that required for arbitrary and capricious behavior; and, in order to avoid penalties under the statute; the employer must have some valid reason or evidence upon which to base its denial of benefits.

Specifically, the WCJ found that, with the filing of the disputed claim for compensation, Defendants were put on notice that Claimant was requesting additional medical treatment. He found that, despite the fact that Dr. Borcicky had not released Claimant, Defendants denied any responsibility for additional treatment. He also stated that Defendants “never allowed claimant to see his own choice of doctor.” For these reasons, the WCJ found the denial of additional treatment by Claimant’s choice of physician was unreasonable, and a penalty of $2,000 was assessed pursuant to La. R.S. 28:1201(F). In addition, the WCJ awarded Claimant’s counsel a fee of $3,000.

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Bluebook (online)
161 So. 3d 976, 2015 La. App. LEXIS 44, 2015 WL 160649, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mccombs-v-gl-jones-construction-inc-lactapp-2015.