Reed v. Direct Installers

669 So. 2d 529, 95 La.App. 4 Cir. 1684, 1996 La. App. LEXIS 115, 1996 WL 39470
CourtLouisiana Court of Appeal
DecidedJanuary 31, 1996
Docket95-CA-1684
StatusPublished
Cited by7 cases

This text of 669 So. 2d 529 (Reed v. Direct Installers) 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
Reed v. Direct Installers, 669 So. 2d 529, 95 La.App. 4 Cir. 1684, 1996 La. App. LEXIS 115, 1996 WL 39470 (La. Ct. App. 1996).

Opinion

669 So.2d 529 (1996)

Leon REED
v.
DIRECT INSTALLERS.

No. 95-CA-1684.

Court of Appeal of Louisiana, Fourth Circuit.

January 31, 1996.

*531 Robert C. Lowther, Jr., Farmer & Burns, Ltd., Covington, for Plaintiff/Appellee.

Teresa C. Leyva, Mayra Leyva, Kristi L. Stroebel, Juge, Napolitano, Leyva & Guilbeau, Metairie, for Defendant/Appellant.

Before CIACCIO, PLOTKIN and MURRAY, JJ.

PLOTKIN, Judge.

The primary issues in the instant appeal are the extent of the continuing disability suffered by claimant Leon Reed when he injured his back while installing carpet during the course and scope of his employment with defendant Direct Installers on May 4, 1992 and the amount of compensation due Reed. The most significant issue is the interpretation of the employer's burden under LSA-R.S. 23:1221(3)(c)(i) to prove the availability of employment to the employee before reducing the employee's supplemental earnings benefits (SEB).

Facts and procedural history

Immediately following his injury, Reed consulted with Dr. John Schuhmacher, who performed a lumbar laminectomy and continued to treat Reed until September 15, 1993, when he found that Reed had reached maximum medical improvement and released Reed to return to work with some restrictions. Between the time of Reed's injuries in May of 1992 and the time that he was released to return to work in October of 1993, defendant State Farm Fire and Casualty Co., Direct Installers' workers' compensation insurer, paid Reed $146.67 per week, calculated on the basis of his average weekly wage of $220. Thereafter, Diana Guevara, senior rehabilitation specialist with Intracorp, identified some jobs available in the New Orleans area which were consistent with the restrictions imposed by Dr. Schuhmacher, on the request of State Farm adjustor Sue Maroney. Dr. Schuhmacher approved those jobs for Reed, and the list was sent to Reed. State Farm then reduced plaintiff's SEB to $33.33, based on the assumption that Reed could perform a minimum wage job 40 hours per week.

On December 3, 1993, some three months after his release by Dr. Schuhmacher, on Dr. *532 Schuhmacher's suggestion, Reed consulted Dr. Bernard L. Manale, an orthopedic surgeon who initially agreed with Dr. Schuhmacher's restrictions. However, Dr. Manale later ordered a functional capacity evaluation. Brian Bienvenu, who performed the functional capacity evaluation, wrote a report recommending that Reed not return to full-time work, but work no more than six hours per day; Ms. Maroney received a copy of that report. After receiving the results of the functional capacity evaluation, Dr. Manale advised Ms. Maroney by letter dated May 6, 1994 as follows:

You should by now have received a copy of the Functional Capacity Evaluation performed by the facility at Touro Infirmary. This document is over ten pages long and gives a lot of information regarding Mr. Reed. The patient appeared to be cooperative and the test appeared to be valid. Considering the severity of the physical restrictions in the job and considering the patient's orthopaedic diagnosis, considering the abnormalities on EMG study and his excessive weight, I believe all might be served best by declaring the patient totally and permanently disabled rather than continuing to exhaust ourselves and the patient and try and get him "back to work." This is my own opinion. I realize the opinion of others may differ.
Therefore, I respectfully request that if this man is allowed to be declared totally and permanent disabled, he can remain under my care for conservative treatment, follow-up and pain medication.

(Emphasis added.) After receiving this correspondence from Dr. Manale, State Farm failed to modify Reed's SEB. The defendants did have Reed examined by Dr. Gordon Nutik, who opined that Reed could work.

The hearing officer found that Reed was not totally and permanently disabled, but he was entitled to "the full amount of indemnity" allowed under supplemental earnings benefits (SEB) as established by LSA-R.S. 23:1221(3), and that the full amount was to be reinstated from the date of the reduction "until it can be legally reduced or eliminated." The "full amount of indemnity" would have entitled Reed to $146.67 per week, the same amount he received as temporary, total disability benefits prior to the reduction. The hearing officer also found that the defendants arbitrarily and capriciously reduced Reed's benefits and awarded $5,000 in attorney fees plus a 12 percent penalty on all back indemnity. Defendants were also cast in judgment for all costs of the proceedings. The hearing officer's award of penalties and attorney fees was based, according to his reasons for judgment, on the fact "that a reduction under SEB was taken; but that after the findings on the March 13, 1994 Functional Capacity Evaluation Test, the SEB reduction should have been based on claimant being a part time rather than a full time employee."

The defendants appeal, claiming that the hearing officer erred by awarding Reed his full compensation rate for SEB and by awarding penalties and attorney fees. Reed answered the appeal, claiming error in the hearing officer's determination that he is not entitled to permanent and total disability benefits, as well as rehabilitation. Reed also seeks damages for frivolous appeal and further attorney fees for work done on appeal.

Extent of Reed's disability

Reed claims that the trial court improperly determined that he was not totally and permanently disabled, based on Dr. Manale's testimony, as well as "logic and common sense."

Determination of whether a claimant is permanently or temporarily totally disabled is a "question of fact that must be determined according to the circumstances of each individual case." Huval Baking Co. v. Fontenot, 629 So.2d 431, 434 (La.App. 3d Cir.1993). Furthermore, that determination is "legal rather than purely medical." Franklin v. Le Meridien Hotel, 93-1328 (La. App. 4th Cir. 3/15/94), 634 So.2d 64. The claimant is required to prove that he is "unable to engage in any gainful occupation, whether or not the same type of work he was engaging in at the time of injury." Schmitt v. City of New Orleans, 632 So.2d 367, 373-74 (La.App. 4th Cir.1993). He must also prove that his disabling injury is permanent *533 and not just for an indefinite period. Id. at 374.

Our review of the record in the instant case convinces us that the trial court was not manifestly erroneous in finding that Reed failed to carry his burden of proving that his disability was total and permanent. Although some of Dr. Manale's comments would indicate that Reed might never be able to hold a job for very long because of the physical problems he would inevitably experience should he return to work, those comments are not sufficient to prove by a preponderance of the evidence that Reed will never again be able to engage in any gainful occupation. Thus, Reed's arguments on this issue have no merit.

The parties agree however that Reed is entitled to some SEB benefits because he is unable to earn at least 90 percent of the wages he received at the time of his injury. The only question is the proper amount of SEB payments.

Amount of SEB payments

Determination of the amount of SEB payments due an injured employee is governed by the provisions of LSA-R.S. 23:1221(3), which provides, in pertinent part, as follows:

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Bluebook (online)
669 So. 2d 529, 95 La.App. 4 Cir. 1684, 1996 La. App. LEXIS 115, 1996 WL 39470, Counsel Stack Legal Research, https://law.counselstack.com/opinion/reed-v-direct-installers-lactapp-1996.