Quigley v. Harbor Seafood & Oyster Bar

182 So. 3d 47, 14 La.App. 5 Cir. 332, 2014 La. App. LEXIS 2486, 2014 WL 11034402
CourtLouisiana Court of Appeal
DecidedOctober 15, 2014
DocketNo. 14-CA-332
StatusPublished

This text of 182 So. 3d 47 (Quigley v. Harbor Seafood & Oyster Bar) 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
Quigley v. Harbor Seafood & Oyster Bar, 182 So. 3d 47, 14 La.App. 5 Cir. 332, 2014 La. App. LEXIS 2486, 2014 WL 11034402 (La. Ct. App. 2014).

Opinion

ROBERT M.. MURPHY, Judge.

IsjClaimant, Kelley Quigley, appeals the November 18, 2013 judgment rendered by the Office of Workers’ Compensation, District 7, dismissing her disputed claim against her former employer, Harbor Seafood & Oyster Bar, Inc., and Louisiana Restaurant Association Self Insured Fund Claims Management (“LRASIF”) for penalties and attorney’s fees. For the reasons that follow, we affirm.

FACTUAL BACKGROUND

Claimant, Kelley Quigley, was employed as a part-time server at defendant, Harbor Seafood & Oyster Bar, Inc., a restaurant located in Kenner, Louisiana. On November 10, 2009, claimant slipped and fell during the course of her employment, which resulted in an injury to her lower back. Following the incident, claimant moved to Georgia where she secured other employment. Harbor Seafood provided claimant with indemnity and medical-benefits, which included compensation for surgery for a herniated lumbar disc on May 8, 2013.

■ ⅛ geptember i3; 2013, claimant filed a Disputed claim for Compensation (Form ⅛08)> alleging ⅛£⅛ defendantS) Harbor geafood and LRASIF; failed to pay ,supplemental earnings benefits (“SEBs”) ¾⅛⅛ May 8, 2018 surgery. Claimant further sought statutory penalties and attorney’s fees as a result - of defendants’ failure to pay SEBs.

In response, defendants filed a motion for summary judgment on October 17, 2013, wherein they asserted that claimant failed to provide defendants with any notice or demand for SEBs prior to the filing of her claim for compensation on September 13, 2013. In support of their motion for summary judgment, defendants attached an affidavit of Jan Provenzano, the adjuster for LRASIF handling Ms. Quig-ley’s claim, averring that she never received any documentation from a physician indicating that claimant had work restrictions, or a Form 1020 indicating that claimant sustained a compensable wage loss since the date.of her surgery. As a result of claimant’s alleged failure to provide defendants with any such request for SEBs, defendants sought to have her claim for SEBs,' penalties and attorney’s fees dismissed with prejudice.

In her November 4, 2013 opposition to defendants’ motion for summary judgment, claimant asserted that because defendants approved and paid for her' back surgery, including - post-operative care, it should have been evident to defendants that claimant was entitled to SEB payments following her surgery. Accordingly, claimant argued that defendants’ failure to conduct any investigation into the nature and extent of her ■ disability for purposes of SEBs warranted an award of past-due SEBs, penalties and attorney’s fees. [49]*49Claimant also filed with, the workers’ compensation court a letter from her physician, Dr. Louis G. Horn, dated November 1, 2013. Dr. Horn’s letter stated that claimant underwent back surgery in May of 2013, and that she was currently receiving physical therapy in an effort to decrease her back pain and to assist her in returning to work. Dr. Horn further stated that claimant was restricted from climbing, twisting, bending, crawling, or | lifting more than fifteen pounds. Additionally, claimant filed her own affidavit, averring that she has been' totally disabled from work since her Surgery, and that her physician denied her requests for verification of her disability because LRASIF had been made aware of her inability to work.

On November 18, 2013, the workers’ compensation court held a hearing on defendants’ motion for suminary judgment. At the hearing, defendants argued that the November 1, 2013 letter from Dr. Horn was the first notice they had received of any disability on behalf of claimant for purposes • of. SEB payments, which was received approximately two months after she filed her disputed claim for compensation. In response, claimant argued that the adjuster was aware of her post-surgery disability and that defendants should have been aware of her need for SEBs, given their extensive knowledge of her initial injury and subsequent.treatment.

At the conclusion of the hearing, the workers’ compensation judge (“WCJ”) denied defendants’ motion for summary judgment. In addition to denying defendants’ motion for summary judgment, the WCJ further ordered defendants' to- pay SEBs to claimant retroactive to the date of her surgery, and ordered claimant to submit 1020 forms to defendants indicating her compensable wage loss retroactive to the date of her surgery. As for claimant’s claim for penalties and attorney’s fees, the WCJ stated that “[claimant] has a. duty if she; wants SEBs' to submit 1020s. She’s not submitting 1020s.”: Accordingly;. the WCJ denied claimant’s claim for penalties and attorney’s fees, and dismissed claimant’s disputed claim without prejudice,: as there were no remaining issues in dispute. On .that-same day, the WCJ signed a judgment to that effect.' Claimant now appeals, and also requests an award of attorney’s fees in connection with this appeal.

■.,-^ASSIGNMENTS OF ERROR

On' appeal, claimant raises the following assignments of error: ■

1. The WCJ erred by failing to award statutory penalties and attorney’s fees, where it awarded retroactive ' SEBs at trial, without finding that ’ defendants reasonably controverted claimant’s claim for SEBs.
2.. The WCJ erred in failing to find that defendants breached their duty to investigate the extent and nature of claimant’s disability prior to and . ■ after her surgery.

LAW AND DISCUSSION

In her first assignment, of error, claimant contends that she is entitled to statutory penalties and attorney’s fees as a result of defendants’ failure to reasonably controvert her claim for SEBs'following her May 8, 2013 surgery.

; Factual determinations in workers’ compensation cases are subject to the manifest error or clearly wrong standard of appellate review. Dean v. Southmark Const., 03-1051 (La.7/6/04), 879 So.2d 112, 118. Under this standard, an appellate court mayt only reverse a workers? compensation judge’s factual findings if it finds from the record that a reasonable factual basis for the finding does not exist, or that examination of the entire record reveals that the finding is clearly erroneous. Wilson v. [50]*50Metropolitan Center, 12-487 (La.App. 5 Cir. 3/13/13), 113 So.3d 261, 266; see also Banks v. Indust. Roofing & Sheet Metal Works, 96-2840 (La.7/1/97), 696 So.2d 561, 556.

•Entitlement to supplemental'-earnings benefits is governed by • La. R.S. 23:1221(3), which provides that the injured employee has the initial burden of proving by a preponderance of the evidence that she is unable to earn wages equal to ninety percent (90%) of her pre-injury wages. Poissenot v. St. Bernard Parish Sheriff's Office, 09-2793 (La.1/9/11), 56 So.3d 170, 174; La. R.S. 3:1221(3)(a)(i). In determining if an injured employee has met her initial burden of proving entitlement to supplemental earnings benefits, the reviewing court must examine | fiall evidence that bears upon the employee’s inability to earn ninety percent or more of his pre-injury wages. Wilson, supra at 266. An ■ injured worker’s testimony that she is no longer able to return to her pre-injury employment, without more, is insufficient to prove entitlement to supplemental earnings benefits. Id. Under La. R.S. 23:1201(C), supplemental earnings benefits “shall become due on the fourteenth day after the employer or insurer has knowledge of the compensable supplemental earnings benefits ...”

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182 So. 3d 47, 14 La.App. 5 Cir. 332, 2014 La. App. LEXIS 2486, 2014 WL 11034402, Counsel Stack Legal Research, https://law.counselstack.com/opinion/quigley-v-harbor-seafood-oyster-bar-lactapp-2014.