Phillips v. Diocese of Lafayette

869 So. 2d 313, 3 La.App. 3 Cir. 1241, 2004 La. App. LEXIS 626, 2004 WL 574461
CourtLouisiana Court of Appeal
DecidedMarch 24, 2004
Docket03-1241
StatusPublished
Cited by29 cases

This text of 869 So. 2d 313 (Phillips v. Diocese of Lafayette) 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
Phillips v. Diocese of Lafayette, 869 So. 2d 313, 3 La.App. 3 Cir. 1241, 2004 La. App. LEXIS 626, 2004 WL 574461 (La. Ct. App. 2004).

Opinion

869 So.2d 313 (2004)

Donna M. PHILLIPS
v.
DIOCESE OF LAFAYETTE.

No. 03-1241.

Court of Appeal of Louisiana, Third Circuit.

March 24, 2004.

*314 Christopher R. Philipp, Lafayette, LA, for Plaintiff/Appellee: Donna M. Phillips.

Eric J. Waltner, Allen & Gooch, Lafayette, LA, for Defendant/Appellant: Diocese of Lafayette.

Court composed of JIMMIE C. PETERS, MICHAEL G. SULLIVAN, and GLENN B. GREMILLION, Judges.

SULLIVAN, Judge.

In this workers' compensation case, the Diocese of Lafayette (the Diocese) appeals a judgment in favor of Donna Phillips rejecting its claim for forfeiture of benefits under La.R.S. 23:1208 and awarding Ms. Phillips penalties and attorney fees for a one-year delay in approving psychotherapy and biofeedback sessions recommended by her treating psychiatrist. Ms. Phillips has answered the appeal, seeking an additional penalty, as well as additional attorney fees for defending this appeal. We affirm and amend as follows.

Factual and Procedural Background

Ms. Phillips was injured on October 11, 1997, as she lifted two food trays while working in a school cafeteria. She was initially treated by Dr. Stanley Foster, an orthopedic surgeon, for pain in her neck and between her shoulder blades that radiated to the left hand and lower back. A cervical MRI indicated degenerative changes at C4-5, C5-6, and C6-7 that Dr. Foster related to some of her pain, as well as a small herniation at C6-7 that caused some compression of the thecal sac, but did not require surgery at that time. In May of 1998, Dr. Foster referred Ms. Phillips to a physiatrist, Dr. Thomas Laborde, who treated her with medication and steroid injections through July of 2002 for chronic pain, diffuse tenderness, and intermittent spasm and trigger points. During the course of his treatment, Dr. Laborde referred Ms. Phillips to a psychologist, Dr. *315 Jimmie Cole, and to a psychiatrist, Dr. Charles Bramlet.

Ms. Phillips had also been evaluated by Dr. John Cobb, an orthopedic surgeon. After reviewing the cervical MRI and a thoracic MRI that showed spondylosis from T6 through T9, Dr. Cobb recommended a cervical fusion and thoracic injections, with a possible thoracic fusion from T6 through T9, should her pain in that area become unacceptable. Dr. Thomas Montgomery, another orthopedic surgeon, did not recommend surgery, as he found no evidence of a compressive neuropathy. The Office of Workers' Compensation (OWC) then ordered an examination by a third orthopedic surgeon, Dr. Angela Mayeux.[1] Dr. Mayeux saw no need for thoracic surgery, and she believed that the cervical procedure recommended by Dr. Cobb would have only a 50% chance of improving Ms. Phillips' symptoms.

The Diocese disputed certain aspects of Ms. Phillips' claim, which resulted in a judgment of March 16, 2001, recognizing her entitlement to supplemental earnings benefits (SEB) at a zero-earnings rate and declaring the reasonableness and medical necessity of the surgical procedure recommended by Cobb. Ms. Phillips never underwent that procedure, but she continued treatment for pain management with Dr. Laborde and Dr. Bramlet.

Dr. Bramlet first saw Ms. Phillips in January of 2001, when she reported a high level of cervical and lower back pain, which significantly limited her physical abilities, and a significant amount of depression and anxiety symptoms, including the loss of interest in pleasurable activities, crying spells, and problems with memory and concentration. Although Dr. Bramlet noted that Ms. Phillips was "a little dramatic with her presentation and detail," he concluded that she met the criteria for chronic cervical and lower back pain, with some radiculopathy and a myofascial component. He also concluded that she exhibited an "anxiety disorder ... chronic in nature from trying to learn to deal with changes that goes [sic] along with dealing with this type of injury." To improve her chances of returning to gainful employment, Dr. Bramlet believed it was necessary to be "extremely aggressive with her treatment" and to "really manage her psychological factors." He proposed several medication changes, as well as ten individual therapy sessions and five biofeedback training sessions.

On February 5, 2001, the Diocese's managed care company denied Dr. Bramlet's request for continued psychotherapy as not "reasonable or necessary for this claimant's soft tissue injury." This denial was affirmed on February 28, 2001 and again on July 19, 2001, with the notation that "it is not reasonable to assume that a soft tissue injury could have precipitated a major psychiatric illness." In the meantime, Dr. Bramlet, who continued to see Ms. Phillips for medication management, believed that she had decompensated since her initial visit, leading him to recommend a more intensive nine-week, half-day program to deal with the worsening of her condition caused by the delay in treatment.

On September 26, 2001, Dr. James Anderson, also a psychiatrist, examined Ms. Phillips at the Diocese's request. Ms. Phillips reported that she experiences tightness in her neck that makes it hard to turn her head, aching under the shoulder blades, and pain around the mid-back and chest that "paralyzes" her. She stated that she is in pain almost every day and that if she did not take her pain medication *316 she would be hurting all the time. Dr. Anderson noted that her MMPI-2 clinical profile, indicating neurotic tendencies, was valid. He further stated that standardized testing supported his clinical impression that a major component of Ms. Phillips' pain is related to psychological issues and functional in origin. He believed that she could benefit from continued psychiatric treatment, including biofeedback, but he considered her a poor candidate for surgical intervention to relieve her pain.

When the Diocese did not provide the requested medical treatment after receiving Dr. Anderson's report, Ms. Phillips filed this disputed claim for medical benefits, penalties, and attorney fees on January 25, 2002. A mediation conference was held on March 19, 2002, after which the Diocese agreed to approve the requested treatment, but still contested the issues of penalties and attorney fees. On May 9, 2002, the Diocese asserted a claim for forfeiture of benefits based upon video surveillance that allegedly "chronicles her ability to move in normal fashion and free of pain."

After a trial, the workers' compensation judge (WCJ) rejected the Diocese's forfeiture defense. Although the WCJ noted that the surveillance was "somewhat at odds with Ms. Phillips' dramatic complaints," the WCJ found that this disparity did not warrant a finding of fraud, given corroboration at trial from Ms. Phillips' neighbors and Ms. Phillips' credible explanations for her conduct. The WCJ also concluded that the severity of Ms. Phillips' complaints to her physicians was based upon unintentional exaggeration or neurotic tendencies as identified by Dr. Anderson in the MMPI-2 profile, rather than wilful misrepresentation. In awarding penalties of $2,000 and attorney fees of $5,000, the WCJ concluded that the Diocese could not rely on surveillance obtained in July of 2001 to reasonably controvert a claim for medical benefits that it initially denied in February of 2001.

Forfeiture of Benefits

In its first assignment of error, the Diocese argues that the WCJ erred in finding that it did not meet its burden of proving that Ms. Phillips violated La.R.S. 23:1208. That statute, in part, provides:

A.

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Bluebook (online)
869 So. 2d 313, 3 La.App. 3 Cir. 1241, 2004 La. App. LEXIS 626, 2004 WL 574461, Counsel Stack Legal Research, https://law.counselstack.com/opinion/phillips-v-diocese-of-lafayette-lactapp-2004.