Romero v. Flowers Baking Co. of Lafayette

114 So. 3d 522, 12 La.App. 3 Cir. 1466, 2013 WL 1809815, 2013 La. App. LEXIS 864
CourtLouisiana Court of Appeal
DecidedMay 1, 2013
DocketNo. 12-1466
StatusPublished
Cited by1 cases

This text of 114 So. 3d 522 (Romero v. Flowers Baking Co. 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
Romero v. Flowers Baking Co. of Lafayette, 114 So. 3d 522, 12 La.App. 3 Cir. 1466, 2013 WL 1809815, 2013 La. App. LEXIS 864 (La. Ct. App. 2013).

Opinions

GENOVESE, Judge.

|TIn this workers’ compensation case, Claimant, Ernest Romero, appeals the judgment of the Office of Workers’ Compensation in favor of his employer, Flowers Baking Company of Lafayette, LLC (Flowers), denying his claims for certain penalties. He also appeals the amount awarded for attorney fees and seeks an additional award of attorney fees for work done on appeal. For the following reasons, we affirm the judgment of the Office of Workers’ Compensation.

FACTUAL AND PROCEDURAL BACKGROUND

Mr. Romero was injured on May 30, 2010, while in the course and scope of his employment with Flowers. On April 13, 2011, Mr. Romero filed a Disputed Claim for Compensation alleging that Flowers: (1) failed to timely pay indemnity benefits for five different pay periods; (2) denied a doctor-recommended electromyo-gram/nerve conduction study (EMG/NCS); [524]*524(3) failed to properly pay mileage expenses incurred in connection with medical treatment and the filling of prescriptions; and (4) failed to timely pay a medical bill for treatment rendered by Dr. John E. Cobb. Flowers denied improperly handling Mr. Romero’s claims and maintained that it had, in fact, timely approved the EMG/ NCS.

Following trial on April 3, 2012, the Workers’ Compensation Judge (WCJ) awarded Mr. Romero: (1) penalties in the amount of $950.00 for Flowers’ failure to timely pay indemnity benefits for three different pay periods; (2) penalties in the amount of $4,000.00 for failure to timely pay mileage reimbursements; and (3) attorney fees in the amount of $5,000.00. The WCJ denied Mr. Romero’s request for penalties for his claims that Flowers denied the doctor-recommended EMG/NCS and failed to timely pay a medical bill for treatment rendered by Dr. Cobb. A judgment was signed on June 18, 2012. Mr. Romero appeals.

| .ASSIGNMENTS OF ERROR

In his appeal, Mr. Romero asserts four assignments of error:

1.) The [WCJ] legally erred in relying upon incompetent hearsay evidence contained in Defendant's] Exhibits 11, 20, and 22.
2.) The [WCJ] erred in denying a penalty under La.R.S. 23:1201(F) for [Flowers’] denial of the EMG testing of Mr. Romero’s upper and lower extremities on October 12, 2011.
3.) The [WCJ] erred in denying a penalty under La.R.S. 23:1201(F) for [Flowers’] late payment of Dr. Cobb’s bill.
4.) The [WCJ] erred in only awarding $5,000.00 in attorney[ ] fees.

Mr. Romero also seeks an additional award of attorney fees for work done on appeal.

LAW AND DISCUSSION

[F]aetual findings in workers’ compensation cases are subject to the manifest error or clearly wrong standard of appellate review. Smith v. Louisiana Dept. of Corrections, 93-1305 (La.2/28/94), 633 So.2d 129, 132; Freeman v. Poulan/Weed Eater, 93-1530 (La.1/14/94), 630 So.2d 733, 737-38. In applying the manifest error-clearly wrong standard, the appellate court must determine not whether the trier of fact was right or wrong, but whether the factfinder’s conclusion was a reasonable one. Freeman, supra at 737-38; Stobart v. State through Dept. of Transp. and Development, 617 So.2d 880, 882 (La.1993); Mart v. Hill, 505 So.2d 1120, 1127 (La.1987).

Poissenot v. St. Bernard Parish Sheriff's Office, 09-2793, p. 6 (La.1/9/11), 56 So.3d 170, 174.

First Assignment of Error

The first assignment of error concerns the admission of evidence. The evidence under consideration relates to the matter raised in Mr. Romero’s second assignment of error — whether the denial of a penalty against Flowers for its alleged failure to timely approve Mr. Romero’s EMG/NCS was error.

| sMr. Romero argues that the WCJ committed legal error by relying upon what he alleges was incompetent evidence in ruling that Flowers had not denied a doctor-recommended EMG/NCS. At trial, Mr. Romero offered Plaintiffs Exhibit 5, a Utilization Review Notice of Denial from Bluegrass Health Network, Inc. (BHN), the utilization review company for Flowers’ workers’ compensation claims. BHN [525]*525concluded that the EMG/NCS was not medically necessary and, on October 12, 2011, sent notice of its recommendation to Flowers that Mr. Romero’s request for said test be denied. The Utilization Review Notice of Denial from BHN to Flowers is what Mr. Romero alleges equates to a denial of the EMG/NCS by Flowers; and, therefore, Flowers owed penalties due to a violation of La.R.S. 23:1201(F). Flowers refutes that it ever denied the test recommended by Dr. Hodges on September 15, 2011. Flowers contends that it approved the administration of Mr. Romero’s EMG/NCS through Alice Turner, an adjuster with Underwriters Safety and Claims (Underwriters).1

At trial, Flowers offered Defendant’s Exhibit 11, its adjuster’s note detailing that on October 25, 2011, forty days after Dr. Hodges requested the EMG/NCS, Ms. Turner called Lafayette Bone and Joint Clinic and advised a member of Dr. Hodges’ staff that the requested EMG/NCS was approved. Flowers also offered into evidence Defendant’s Exhibit 20, correspondence from its counsel to Mr. Romero’s counsel dated February 3, 2012, and Defendant’s Exhibit 22, correspondence from its counsel to Dr. Hodges dated February 27, 2012. According to Flowers, the letters its counsel sent to Mr. Romero’s counsel and to Dr. Hodges were sent in an effort to explain that an approval had been 1.1communicated through Ms. Turner since October 2011, and that Mr. Romero could, and should, submit to an EMG/NCS.2

In ruling on the issue of whether of Mr. Romero was entitled to a penalty for Flowers’ denial of the EMG/NCS, the WCJ stated:

The controversy stems from Dr. Hodges’ September 15, 2011 request for the EMG/NCS. The Utilization review recommended that the test be denied, however, [Flowers] did not rely on the utilization review. According to Defendant’s Exhibit 11, titled “Detail Notes;” with a date entered on October 25, 2011, and I’m quoting, “PC to Lafayette Bone & Joint. Spoke with Allie. Approved the EMG/NCS. Requested that they send it through One Call Medical.” This was. done within 60 days of the recommended tests by Dr. Hodges. Being that .penal statutes are strictly eonstrued[,] the [c]ourt denies penalties in regard to, the EMG/NCS.

On appeal, Mr. Romero asserts that the WCJ committed legal error when it relied upon incompetent evidence and “denied a penalty for [Flowers’] denial of EMG testing recommended by Dr. [Ricardo] Leoni and Dr. [Daniel] Hodges by relying upon [Flowers’] adjuster’s claim notes (Defendant[’s] Exhibit 11) and correspondence from counsel for [Flowers] ([Defendant’s] Exhibits 20 and 22)[,] which are hearsay, unreliable!,] and ‘self-serving’ documents.” Thus, Mr. Romero asserts that due to the trial court’s error in relying upon the incompetent evidence, we “must conduct a de novo review • of the competent record evidence, with no deference being given to the judge’s findings of fact.”

Evidentiary standards in workers’ compensation cases are relaxed by comparison to those in ordinary civil actions. Louisiana Revised Statutes 23:1317(A) provides, in pertinent part that “[t]he workers’ compensation judge shall not be bound by technical rules of evidence or procedure other than as herein provided, but all find[526]

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Bluebook (online)
114 So. 3d 522, 12 La.App. 3 Cir. 1466, 2013 WL 1809815, 2013 La. App. LEXIS 864, Counsel Stack Legal Research, https://law.counselstack.com/opinion/romero-v-flowers-baking-co-of-lafayette-lactapp-2013.