Nuzum v. TCI Turner Corp.

857 So. 2d 520, 2003 WL 1702122
CourtLouisiana Court of Appeal
DecidedMay 30, 2003
Docket2002 CA 1232
StatusPublished
Cited by3 cases

This text of 857 So. 2d 520 (Nuzum v. TCI Turner Corp.) 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
Nuzum v. TCI Turner Corp., 857 So. 2d 520, 2003 WL 1702122 (La. Ct. App. 2003).

Opinion

857 So.2d 520 (2003)

Randy NUZUM Consolidated with Craig Brigalia
v.
TCI TURNER CORPORATION.

No. 2002 CA 1232.

Court of Appeal of Louisiana, First Circuit.

March 28, 2003.
Order Granting Rehearing May 30, 2003.

*521 Leonard Cardenas, Baton Rouge, Counsel for Appellee/2nd Appellants Randy Nuzum and Craig Brigalia.

Terri Collins, Brent Bourgeois, Baton Rouge, Counsel for Appellant/2nd Appellees TCI Turner Corporation.

Before: FOIL, McCLENDON, and KLINE,[1] JJ.

KLINE, J.

In this workers' compensation action, the employer, TCI Turner Corporation ("TCI"), appeals a judgment in favor of claimants, Randy Nuzum and Craig Brigalia, whose claims were consolidated for trial. For the following reasons, we affirm.

FACTS AND PROCEDURAL HISTORY

Randy Nuzum and Craig Brigalia were both employed as pipefitters by TCI at the Marathon Oil Plant in Garyville, Louisiana. On January 19, 1998, both claimants suffered exposure to toxic chemical fumes during the course and scope of their employment at TCI. As a result of the exposure, both claimants suffered a number of medical problems, including upper and lower respiratory injuries, and claimed to be totally disabled. TCI paid indemnity benefits to both.

On February 15, 1999, claimants filed separate disputed claims for compensation with the Office of Workers' Compensation, basing their claims on TCI's refusal to authorize recommended medical tests and treatment, and TCI's refusal of their choice of physician. Claimants asserted that TCI failed and/or refused to pay for the evaluation and treatment by Dr. Thomas Callender, a medical toxicologist and/or occupational medical specialist. They also asserted that TCI further failed to pay for recommended diagnostic treatment and diagnostic testing and studies. Claimants alleged that, in addition to being entitled to payment of all medical treatment *522 by TCI, they were also entitled to penalties and attorney's fees since employer failed to reasonably controvert those claims and were arbitrary and capricious in denying payment.

TCI denied claimants' assertions and argued that it had already agreed to pay for treatment and evaluation by Dr. Callender to the extent that it was subject to the fee schedule and was reasonable and necessary. TCI alleged that Crawford & Company, third party administrator for TCI, was awaiting the appropriate insurance forms from Dr. Callender's office necessary to properly process the medical bills. TCI denied being arbitrary and capricious in its handling and processing of claimants' claims.

On November 20, 2000, the workers' compensation judge ("WCJ") ruled that the November 20, 2000 trial date be continued indefinitely and that the claims be stayed pending the outcome of claimants' third party tort action against Marathon Oil Company, subject to being reactivated upon request of either party. The third party action was dismissed in favor of Marathon Oil Company. On April 9, 2001, claimants filed a motion to re-open the case.

A trial on the merits was held on October 24, 2001. The matter was taken under advisement at that time by the WCJ and, following submission of post trial memoranda on behalf of the parties, an oral ruling was issued on November 16, 2001. The judgment was signed on December 3, 2001. The judgment of the WCJ stated the following:

(1) [R]andy Nuzum's tonsillectomy is found to be related to his workplace chemical exposure. Claimant is entitled to reimbursement of any related medical expenses, including surgery and prescription expenses in accordance with the workers' compensation fee schedule. Claimant is further entitled to a penalty in the amount of $2,000.00 due to the defendant's failure to timely pay these benefits. Claimant's attorney is hereby awarded $4000.00 in attorney's fees for the defendant's failure to timely pay these benefits.
(2) [T]he defendant failed to timely pay accident-related medical expenses from Our Lady of Lourdes and Dr. Perret on behalf of both Randy Nuzum and Craig Brigalia. Each claimant is hereby awarded a $2,000.00 penalty for defendant's failure to timely pay these benefits. Counsel for claimant's[sic] is hereby awarded $4,000.00 in additional attorney's fees, reflecting $2,000.00 on behalf of each claimant for these untimely payments.
(3) [T]he defendant did not have grounds to require a HCFA form prior to forwarding payment for numerous medical bills which resulted in the untimely payment of said bills. Each claimant is hereby awarded a $2,000.00 penalty for said untimely payments. Counsel for claimants is entitled to an additional attorney's fee in the amount of $2,000.00, reflecting $1,000.00 for each claimant due to these untimely payments.
(4) [A]ll healthcare providers who have treated Randy Nuzum and/or Craig Brigalia for their work-related injuries are only entitled to reimbursement for said treatment in the amount provided for under the fee schedule promulgated by the [OWC]. In the event that either claimant or their counsel has made payment to any such healthcare provider in an amount exceeding that called for in the fee schedule, it is ordered that the claimants and/or their counsel shall be reimbursed the amount of any such overpayment by the respective healthcare providers. Dr. Thomas Callender *523 is specifically excluded from this order given the contract entered between Dr. Callender and counsel for claimants.
(5) [D]efendant shall pay and/or reimburse any prescription expenses related to the claimants' workplace injuries and symptoms. Within sixty days from receipt of this signed Judgment, it shall be the defendant's duty to request an updated printout from claimants' pharmacies (specifically including Eckerds) and forward payment for said accident-related prescription expenses.
(6) [D]efendant shall pay judicial interest on all penalties, attorney's fees and medical benefits awarded herein from the date of Judgment until paid.

TCI appeals the WCJ's judgment and asserts the following assignments of error:

I. Manifest errors concerning HCFA 1500 form
A. The Office of Workers' Compensation manifestly erred in finding that the employer did not have grounds to require that healthcare providers (or claimants) submit a HCFA 1500 form prior to payment of medical charges by the employer.
B. The Office of Workers' Compensation manifestly erred in finding that payments by the employer for medical charges were untimely when the delay for payment of those charges was based solely upon a failure on the part of the claimants and/or their healthcare providers to provide a HCFA 1500 form to the employer.
C. The office of Workers' Compensation manifestly erred in ordering the employer to pay $6000 in penalties and attorneys' fees as a result of its finding that the employer could not require submission of a HCFA 1500 form prior to payment of medical charges.
II. Manifest errors concerning Randy Nuzum's tonsillectomy
A. The Office of Workers' Compensation manifestly erred in finding that Randy Nuzum's tonsillectomy was related to his workplace chemical exposure and was reasonably necessary.
B. The Office of Workers' Compensation manifestly erred in finding that the employer failed to timely pay benefits associated with Randy Nuzum's tonsillectomy.
C.

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

Related

Mona Leblanc v. Walmart Distribution Center
Louisiana Court of Appeal, 2024
Daenen v. Cajun Landing Restaurant
899 So. 2d 125 (Louisiana Court of Appeal, 2005)
Semere v. Our Lady of Lourdes Hosp.
875 So. 2d 1048 (Louisiana Court of Appeal, 2004)
Mary Semere v. Our Lady of Lourdes Hospital
Louisiana Court of Appeal, 2004
Perron v. ST. LANDRY PARISH ECON. DIST.
867 So. 2d 86 (Louisiana Court of Appeal, 2004)

Cite This Page — Counsel Stack

Bluebook (online)
857 So. 2d 520, 2003 WL 1702122, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nuzum-v-tci-turner-corp-lactapp-2003.