Robbins v. Schumpert Medical Center

814 So. 2d 737, 2002 La. App. LEXIS 962, 2002 WL 496992
CourtLouisiana Court of Appeal
DecidedApril 3, 2002
DocketNo. 35,932-WCA
StatusPublished
Cited by3 cases

This text of 814 So. 2d 737 (Robbins v. Schumpert Medical Center) 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
Robbins v. Schumpert Medical Center, 814 So. 2d 737, 2002 La. App. LEXIS 962, 2002 WL 496992 (La. Ct. App. 2002).

Opinions

| T PEATROSS, J.

This is an appeal from the denial by the Worker’s Compensation Judge (“trial court”) of Plaintiffs, Julie A. Robbins, claims against Defendant, Schumpert Medical Center, arising from Defendant’s failure to approve medical tests and to pay supplemental earnings benefits (“SEBs”). For the reasons stated herein, we affirm.

FACTS

On January 19, 1996, Plaintiff injured her back (L5 lumbar disc) while in the course and scope' of her duties as an employee of Defendant. Defendant paid temporary total disability benefits (“TTDs”) to Plaintiff from January 19,1996, to September 19, 1997, and again from April 7, 1998, to May 11, 1998. The parties stipulated that Plaintiffs pre-injury wages were [739]*739$285.20 and that the compensation for TTDs was $190.13. Additionally, in August 2000, Plaintiff was paid SEBs in an amount of $509.36.

Plaintiff underwent two surgeries as a result of her injury. Subsequently, she was examined by Dr. Robert Holladay on October 5, 1999, June 9, 2000, July 14, 2000 (an MRI was performed on this day), July 18, 2000, and August 14, 2000. As a result of his findings, Dr. Holladay, on July 18, 2000 and again on August 14, 2000, recommended that a CT scan and discogram be performed for further diagnostic purposes.

Defendant, however, denied approval of those tests because it obtained a second opinion from Dr. Gordon Mead, who had examined Plaintiff on January 17, 2000. Dr. Mead testified that the procedures were knot necessary because they would only reveal whether further surgery was warranted. It was Dr. Mead’s opinion that another surgery would expand the amount of scar tissue in the affected area and increase Plaintiffs pain. Dr. Mead rendered this opinion on August 24, 2000, but he had not examined Plaintiff since January 17, 2000, nor had he reviewed her MRI report. After a hearing, the trial court ordered the tests.

On August 14, 2000, Dr. Holladay stated that Plaintiff was temporarily totally disabled as a result of her injury and resulting pain, but that she could resume working after completing a pain management program. The parties stipulated that, since Defendant had made its last TTD payment to Plaintiff in May 1998, all claims for TTDs had prescribed. Plaintiff sought SEBs from August 14, 2000 and Defendant denied payment.

The trial court found that:

1. Defendant was not arbitrary and capricious in denying payment for the dis-cogram and CT scan;
2. Plaintiff was not entitled to TTDs from August 14, 2000, through the date of judgment because her claim for TTDs had prescribed because more than one year had elapsed from the time of the last TTD payment and the filing of her claim;
3. Defendant was not arbitrary and capricious in denying SEBs from August 14, 2000;
4. Plaintiff was not entitled to SEBs from August 14, 2000;1 and
5. Plaintiffs claim for SEBs had not prescribed.

On appeal, Plaintiff raises the following assignments of error:

|91. The trial court erred in denying Plaintiffs claim for penalties and attorney fees for Defendant’s failure to approve medical benefits;
2. the trial court erred in denying Plaintiffs claim for SEBs from August 14, 2000; and
3. the trial court erred in denying attorney fees for Defendant’s failure to approve SEBs from August 14, 2000.

DISCUSSION

Plaintiff first argues that the trial court erred in denying her claim for penalties and attorney fees because Defendant failed to approve necessary medical benefits. The factual issues decided by the trial court in a worker’s compensation case may not be reversed absent manifest er[740]*740ror. See Todd v. Security Industrial Insurance, 33,233 (La.App.2d Cir.5/15/00), 759 So.2d 1082.

Louisiana law provides for the assessment of attorney fees if an employer’s denial of a claim is not reasonably controverted.

Failure to provide payment in accordance with this Section shall result in the assessment of a penalty in an amount equal to twelve percent of any unpaid compensation or medical benefits or fifty dollars per calendar day, whichever is greater, for each day in which any and all compensation or medical benefits remain unpaid, together with reasonable attorney fees for each disputed claim; however, the fifty dollars per calendar day penalty shall not exceed a maximum of two thousand dollars in the aggregate for any claim. Penalties shall be assessed in the following manner:
(1) Such penalty and attorney fees shall be assessed against either the employer or the insurer, depending upon fault. No workers’ compensation insurance policy shall provide that these sums shall be paid by the insurer if the workers’ compensation judge determines that the penalty and attorney fees are to be paid by the employer rather than the insurer.
(2) This Subsection shall not apply if the claim is reasonably controverted or if such nonpayment results from conditions over which the employer or insurer had no control.

|4La. R.S. 23:1201(F). Plaintiff contends that the necessity of the tests recommended by Dr. Holladay was not reasonably controverted because Dr. Mead had not examined Plaintiff for approximately seven months and had not reviewed her MRI.

A claim is reasonably controverted, however, “when the employer or insurer produces factual or medical information of such a nature that it reasonably counters the claimant’s evidence.” Nunn v. CBC Services, Inc., 32,491 (La.App.2d Cir.1/26/00), 750 So.2d 474. Furthermore, penalties are stricti juris and should be imposed only when the facts clearly negate good faith and just cause in connection with the refusal to pay. Nowlin v. Breck Construction Co., 30,622 (La.App.2d Cir.6/24/98), 715 So.2d 112. Although we are cognizant of the fact that Dr. Mead neither examined Plaintiff after January 17, 2000, nor reviewed her MRI at the time of his recommendation, it is not the responsibility of the employer to tell the second medical opinion physician what he must and must not review. We find that Defendant denied the CT scan and disco-gram in good faith because Dr. Mead opined that the tests were not necessary. In addition, we note that Plaintiffs course of treatment did not change after the trial court ordered the CT scan and discogram. Thus, we conclude that the trial court was not manifestly erroneous in finding that Defendant’s reliance on Dr. Mead’s opinion was reasonable.

In her next assignment of error, Plaintiff argues that the trial court erred in denying her claim for SEBs from August 14, 2000. The parties, in 1.¡brief, stipulated that Plaintiff was temporarily totally disabled from that date and that any claims for TTDs had prescribed.

TTDs and SEBs are defined and distinguished as follows:

(1) Temporary total.
(a) For any injury producing temporary total disability of an employee to engage in any self-employment or occupation for wages, whether or not the same or a similar occupation as that in which the employee was customarily engaged [741]

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Bluebook (online)
814 So. 2d 737, 2002 La. App. LEXIS 962, 2002 WL 496992, Counsel Stack Legal Research, https://law.counselstack.com/opinion/robbins-v-schumpert-medical-center-lactapp-2002.