Russo v. Sewerage & Water Board of New Orleans

813 So. 2d 491, 2001 La.App. 4 Cir. 0575, 2002 La. App. LEXIS 611, 2002 WL 363380
CourtLouisiana Court of Appeal
DecidedMarch 6, 2002
DocketNo. 2001-CA-0575
StatusPublished

This text of 813 So. 2d 491 (Russo v. Sewerage & Water Board of New Orleans) 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
Russo v. Sewerage & Water Board of New Orleans, 813 So. 2d 491, 2001 La.App. 4 Cir. 0575, 2002 La. App. LEXIS 611, 2002 WL 363380 (La. Ct. App. 2002).

Opinion

L JOAN BERNARD ARMSTRONG, Judge.

This is a workers’ compensation case. The workers’ compensation judge (“WCJ”) awarded penalties due to late payment of medical bills. The WCJ also ordered that the claimant employee be examined by a particular physician as to whether she needed knee surgery and, if the physician recommends surgery, that the employer pay for that surgery. The employer appeals. We affirm in part, reverse in part, and remand.

The claimant employee is Betty Russo. The employer is the Sewerage and Water Board of New Orleans (“S & WB”).

Ms. Russo has an employment-related knee injury. She has had a number of doctor visits, MRI’s etc. in connection with that injury. It is uncontested that the S & WB did not pay some of the medical bills for those doctor visits and procedures within 60 days as is required by statute, La.R.S. 23:1201.E, and, as of the time of trial, they were still unpaid. The WCJ ordered the S & WB to pay the unpaid medical bills. The S & WB does not appeal that part of the WCJ’s judgment.

| ¡¡.The WCJ also awarded Ms. Russo statutory penalties, La. R.S. 1201.F, for the late payment of the medical bills. The S & WB appeals the award of penalties and advances two arguments on appeal.

First, the S & WB argues, based upon La. R.S. 23:1201.F(4), that only a health care provider, and not an employee claimant, may be awarded penalties for late payment of medical bills. We disagree. Subsection F provides:

F. 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.
(3) Except as provided in Paragraph
(4)of this Subsection, any additional compensation paid by the employer or insurer pursuant to this Section shall be paid directly to the employee.
(4) In the event that the health care provider prevails on a claim for payment of his fee, penalties as provided in this Section and reasonable attorney fees based upon actual hours worked may be awarded and paid directly to the health care provider. This Subsection shall not be construed to provide for recovery of more than one penalty or attorney fee.
h(5) No amount paid as a penalty or attorney fee under this Subsection shall be included in any formula utilized to establish premium rates for workers’ compensation insurance.

Sub-subsection (4) provides that, in the event that there is a successful claim by a health care provider for payment of his [494]*494fee, then a penalty may be awarded and paid directly to the health care provider. However, sub-subsection (4) does not address the situation, as in the present case, where there is no claim made by the health care provider.

Moreover, sub-subsection (4) does not state that only health care providers can recover a penalty for late payment of the health providers fees. In 1993, an employee claimant for the first time was given the right to recover a penalty for late payment of a health care provider’s fee. Manuel v. River Parish Disposal, Inc., 96-302 (La. App 5 Cir. 10/01/96), 683 so.2d 791, 798. In 1995, for the first time, the health care provider was given the right to recover a penalty for late payment of his fee. Manuel, supra, and, also in 1995, a statutory prohibition on more than one penalty was added. McLaughlin v. Hill City Oil Co./Jubilee Exxon, 97-0577 (La.App. 3 Cir. 10/09/97), 702 So.2d 786, 793, unit denied, (La.02/13/98), 706 So.2d 994. The net result of these statutory amendments is that either the employee claimant or the health care provider, but not both as to the same late payment, may recover a late payment penalty.

We note that sub-subsection (3) begins with the introductory clause: “Except as provided by Paragraph [i.e. sub-subsection] (4) of this Subsection”. However, we do not believe that that clause eliminates in all cases the employee claimant’s | ¿right to recover a penalty for late payment of a health care provider’s fee. This is because sub-subsection(4) begins with the introductory clause: “In the event that the health care provider prevails on a claim for payment of his fee ... ” (emphasis added). If there is no claim by the health care provider, then sub-section (4) is not applicable and so, the exception to the employee claimant’s right to recover a penalty for late medical payments, i.e. the introductory clause to sub-subsection (3), is not implicated. Consequently, if there is no claim by the health care provider so that the health care provider is not seeking a late payment penalty, then the claimant employee may seek the late payment penalty. If there is a claim by the health care provider, so that the health care provider might be awarded a late payment penalty, then the employee claimant may not seek the penalty. In short, only one penalty may be recovered, as per the last section of sub-subsection (4), and the employee claimant may seek that penalty unless the health care provider seeks it.

The S & WB’s second argument as to why a late payment penalty should not have been awarded is that, under La. R.S. 23:1201.F(2), no penalty should be awarded “if the claim is reasonably controverted or if such nonpayment results from conditions over which the employer or an insurer had no control”. However, the WCJ found, and the S & WB’s own testimony showed, that the late payment of the medical bills in question resulted from the S & WB’s turning them over to an outside contractor that was in the business of negotiating price reductions with health care providers. The bills were given to the outside company by the S & WB 1 sand, because for some unspecified computer glitch, they were not returned to the S & WB for more than two months. The WCJ found that, because the S & WB decided to turn the medical bills over to the outside company, the late payment was not due to conditions over which the S & WB had no control. We agree and add that, based upon the record, there is no reason apparent that the S & WB could not keep track of the time that the outside company had the bills so that the S & WB could require their return in time to pay them within 60 days. Also, the S & WB could have re[495]*495tained a photocopy of the bills sent to the outside company or retained the originals and sent photocopies to the outside company.

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Related

McLaughlin v. Hill City Oil Co./Jubilee Exxon
702 So. 2d 786 (Louisiana Court of Appeal, 1997)

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Bluebook (online)
813 So. 2d 491, 2001 La.App. 4 Cir. 0575, 2002 La. App. LEXIS 611, 2002 WL 363380, Counsel Stack Legal Research, https://law.counselstack.com/opinion/russo-v-sewerage-water-board-of-new-orleans-lactapp-2002.