Musson Patout Automotive Group v. Jimmy Maynard

CourtLouisiana Court of Appeal
DecidedJanuary 27, 2021
DocketWCA-0020-0218
StatusUnknown

This text of Musson Patout Automotive Group v. Jimmy Maynard (Musson Patout Automotive Group v. Jimmy Maynard) 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
Musson Patout Automotive Group v. Jimmy Maynard, (La. Ct. App. 2021).

Opinion

STATE OF LOUISIANA COURT OF APPEAL, THIRD CIRCUIT

20-218

MUSSON PATOUT AUTOMOTIVE GROUP VERSUS JIMMY MAYNARD Consolidated with 20-219 JIMMY MAYNARD VERSUS

MUSSON PATOUT AUTOMOTIVE GROUP

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APPEAL FROM THE OFFICE OF WORKERS’ COMPENSATION — DISTRICT NO. 4 PARISH OF LAFAYETTE, NO. 18-08513 C/W 19-00336 ANTHONY PALERMO, WORKERS’ COMPENSATION JUDGE

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VAN H. KYZAR JUDGE

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Court composed of Shannon J. Gremillion, Van H. Kyzar, and Candyce G. Perret, Judges.

AFFIRMED AS AMENDED. Timothy E. Benedetto

Workers’ Compensation, L.L.C.

3045 Ridgelake Drive, Suite 203

Metairie, LA 70002

(504) 838-8883

COUNSEL FOR DEFENDANT/PLAINTIFF/APPELLANT: Jimmy Maynard

Corey M. Meaux

Allen & Gooch, A Law Corporation

P. O. Box 81129

Lafayette, LA 70598-1129

(337) 291-1630

COUNSEL FOR PLAINTIFF/DEFENDANT/APPELLEE: Musson Patout Automotive Group KYZAR, Judge.

The employee, Jimmy Maynard, appeals from a workers’ compensation judgment awarding him penalties and attorney fees based on the employer’s failure to timely authorize surgery. For the reasons herein, we affirm as amended.

DISCUSSION OF THE RECORD

Mr. Maynard, an employee of Musson Patout Automotive Group, Inc. (Musson Patout), was injured while in the course and scope of his employment as a result of a June 12, 2018 motor vehicle accident. Musson Patout commenced paying him indemnity benefits as a result of this accident. Mr. Maynard was diagnosed by Dr. John B. Sledge, III, an orthopedic surgeon, with other spondylosis, other cervical disc degeneration, spinal stenosis, and radiculopathy in the cervical region; other spondylosis with radiculopathy, intervertebral disc disorders with radiculopathy, and other intervertebral disc displacement in the lumbar region, as well as low back pain.

Based on Mr. Maynard’s failure to respond to conservative treatment, Dr. Sledge submitted an LWC Form 1010 on October 4, 2018, requesting authorization from Risk Management Services, LLC (Risk Management), Musson Patout’s third party administrator, to perform a transforaminal lumbar interbody fusion, consisting of a two-level lumbar decompression and fusion at L3-4 and L4-5. However, Risk Management’s utilization reviewer, Novare Utilization Review (Novare), denied authorization for the surgery on October 11, 2018, finding that it was not in accordance with the Medical Treatment Schedule or La.R.S. 23:1203.1(D) because Mr. Maynard had not undergone a pre-surgical psychological evaluation. In response to this denial, Dr. Sledge requested authorization for Mr. Maynard to undergo a psychological evaluation in accordance with the Medical Treatment

Guidelines, which was approved by Novare on October 25, 2018. On October 24, 2018, Mr. Maynard underwent a second medical opinion (SMO) evaluation by Dr. Thad S. Broussard, an orthopedic surgeon, at the request of Risk Management. Dr. Broussard related Mr. Maynard’s symptoms to his June 12, 2018 accident and stated that the treatment received by him was “reasonable, appropriate and necessary.” He stated that Mr. Maynard had not yet reached maximum medical improvement, estimating that this would not occur until at least six months post-accident. However, Dr. Broussard opined that Mr. Maynard was not a candidate for surgery because his pain was controllable with medication and because there was no documented objective evidence of radiculopathy. He further stated that he felt that Mr. Maynard could return to work and that any question regarding his ability to work could be addressed through a functional capacity evaluation.

After Mr. Maynard was cleared psychologically for surgery by Dr. Jean Boudreaux, a licensed psychologist, Dr. Sledge resubmitted the request for surgery on December 10, 2018, which was approved with modifications by Novare on December 13, 2018. However, that same day, Danielle Rogers, Risk Management’s claims adjuster, denied authorization, stating that the “Previous approval is now rescinded. Pending conference with treating physician.”

On December 19, 2018, Musson Patout filed a disputed claim for compensation (Docket Number 18-08513) in the Office of Workers’ Compensation, District 09, which included a motion for a court-appointed independent medical examination (IME). Because of Dr. Sledge’s and Dr. Broussard’s conflicting medical opinions, Musson Patout asked that a physician be appointed to evaluate Mr.

Maynard in order to address the following questions:

Although Ms. Rogers was scheduled to meet with Dr. Sledge on January 28, 2019, that meeting was canceled on January 22. 2019, after Musson Patout filed its IME request.

2 e What is claimant’s current work status as it pertains to the alleged work-related incident?

Specifically: a) Can claimant return to work at this time?

b) If so, does claimant have any restrictions, including daily hour limitations?

c) If any restrictions are applicable, please state all restrictions?

d) What capacity or level of duty is claimant able to work?

e What is claimant’s current medical condition?

e Isclaimant’s current medical condition indicative of the need for additional medical treatment, including surgical intervention?

In addition to opposing Musson Patout’s motion on January 10, 2019, Mr. Maynard filed a disputed claim for compensation (Docket Number 19-00336) in the Office of Workers’ Compensation, District 04, alleging that the following bona fide disputes with Musson Patout: incorrect workers’ compensation rate; failure to authorize medical treatment recommended by Dr. Sledge; disability status, temporary total disability; and all other equitable relief owed, including penalties and attorney fees, reimbursement of costs, and judicial interest. That same day, Mr. Maynard moved to transfer venue in Docket Number 18-08513 to District 04 in Lafayette Parish, the parish of his domicile. An order granting the motion was rendered by the WCJ on February 21, 2019.

On March 6, 2018, in Docket Number 19-00336, the parties entered into a consent judgment, finding that Mr. Maynard’s accident occurred in the course and scope of his employment with Musson Patout; that Musson Patout had miscalculated Mr. Maynard’s average weekly wage (AWW) and workers’ compensation rate, that

the correct rates were $541.62 and $361.08, respectively, and that Musson Patout owed Mr. Maynard $2,000.00 in penalties for the miscalculation; that all other issues were reserved for trial; that Mr. Maynard’s entitlement to future indemnity benefits would be governed by the Workers’ Compensation Act; and that Risk Management, as Musson Patout’s third party administrator, was not a defendant in the litigation.

On March 8, 2019, in Docket Number 18-08516, Musson Patout filed a motion to consolidate the two workers’ compensation claims under that docket number, which was granted on March 11, 2019. On April 24, 2019, the WCJ issued an order that Mr. Maynard submit to an IME by Dr. Thomas Butaud on June 5, 2019. The Office of Workers’ Compensation Administration’s letter of that same date to Dr. Butaud specified that he was to address Mr. Maynard’s ability to return to work.

Following the examination, Dr. Butaud issued a report, finding that Mr. Maynard’s cervical issues had resolved but that he had significant degenerative changes in his lumbar spine, especially at L3-4 and L4-5, “with disc pathology to the right at L4-5[.]” However, Dr. Butaud felt that because Mr. Maynard also had degenerative changes in his right hip, it was not clear whether his right leg pain emanated from his lumbar spine or his right hip. Thus, he recommended delaying surgery so that Mr. Maynard could undergo nerve testing and a right-hip injection.

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