Sinegal v. Able Glass Co., Inc.

663 So. 2d 393, 95 La.App. 3 Cir. 10, 1995 La. App. LEXIS 2655, 1995 WL 595790
CourtLouisiana Court of Appeal
DecidedOctober 11, 1995
Docket95-10
StatusPublished
Cited by11 cases

This text of 663 So. 2d 393 (Sinegal v. Able Glass Co., Inc.) 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
Sinegal v. Able Glass Co., Inc., 663 So. 2d 393, 95 La.App. 3 Cir. 10, 1995 La. App. LEXIS 2655, 1995 WL 595790 (La. Ct. App. 1995).

Opinion

663 So.2d 393 (1995)

Hayward SINEGAL, Plaintiff-Appellee,
v.
ABLE GLASS COMPANY, INC., Defendant-Appellant.

No. 95-10.

Court of Appeal of Louisiana, Third Circuit.

October 11, 1995.

*394 Thomas Anthony Budetti, Lafayette, for Hayward Sinegal.

Christopher R. Philipp, Lafayette, for Able Glass.

Before DOUCET, C.J., and LABORDE[*], WOODARD, AMY and SULLIVAN, JJ.

WOODARD, Judge.

The issues on appeal are whether defendant was arbitrary and capricious in handling plaintiff's claim and whether the hearing officer abused her discretion in awarding plaintiff $3,000.00 in attorney's fees.

FACTS

Plaintiff, Hayward Sinegal, who was employed by defendant, Able Glass Company, Inc., injured his chest and lower back in the course of his employment on July 21, 1992 when the brakes of the company truck he was driving failed, causing him to smash into the rear end of another vehicle. Able Glass paid Sinegal $202.45 per week in temporary total disability (TTD) benefits from the date of the accident until April 9, 1993, when it received information from Dr. Clifton W. Shepherd, Jr., its orthopedic surgeon, that Sinegal had been "released from care without restrictions."

Sinegal subsequently brought suit against Able Glass, requesting (1) that his TTD benefits and medical expenses be reinstated and (2) that he be awarded attorney's fees and penalties. On November 3, 1993, Able Glass reinstated Sinegal's TTD benefits retroactive to April 9, 1993 after Dr. James Lafleur, an orthopedic surgeon who was appointed by the Office of Workers' Compensation to conduct an independent medical examination of Sinegal, opined that Sinegal still suffered from a compensable disability. The case was tried on July 7, 1994. The hearing officer rendered judgment on September 9, 1994 in favor of Sinegal, finding that Able Glass was arbitrary and capricious for failing to (1) properly investigate Sinegal's disability status when his benefits were terminated and (2) authorize an MRI and treatment recommended by Dr. Louis Blanda, Sinegal's orthopedic surgeon. The hearing officer awarded Sinegal $2,000.00 in penalties and $3,000.00 in attorney's fees.

Able Glass appeals from that judgment and asserts that the hearing officer erred in finding that it was arbitrary and capricious in handling Sinegal's claim. Sinegal answered the appeal and asserts that the hearing officer erred in awarding only $3,000.00 in attorney's fees. He also requests additional attorney's fees for time spent pursuing this appeal.

LAW

It is well settled that a workers' compensation claimant is not entitled to attorney's fees and penalties unless the withholding or terminating of benefits is found to be arbitrary, capricious or without probable cause. La.R.S. 23:1201; 1201.2. Whether or not the termination of benefits is arbitrary, capricious or without probable cause depends primarily on the facts known to the employer at the time of its action. Miles v. F.D. Shay Contractor, Inc., 626 So.2d 74 (La.App. 3 Cir.1993). An employer is required to make a reasonable investigation to ascertain the *395 claimant's exact medical condition before benefits are terminated. Johnson v. Insurance Company of North America, 454 So.2d 1113 (La.1984). A hearing officer has great discretion in the award of attorney's fees and penalties, and his or her decision will not be disturbed by an appellate court unless it is clearly wrong. Dietz v. Guichard Drilling Company, 626 So.2d 79 (La.App. 3 Cir.1993).

After the accident, Sinegal was treated by Dr. Michael E. Boustany, a general practitioner, for approximately five months. On January 11, 1993, Dr. Boustany diagnosed Sinegal with a strain of the lumbar and cervical musculature and a contusion of his chest wall, because he found that Sinegal's cervical area was "tense," both of his trapezius muscles were sore and tender, and his lumbar area was tender to palpation. Dr. Boustany gave Sinegal robazin for muscle relaxant, ansaid for pain, and myoflex cream to apply to his injured areas and recommended that he receive physical therapy three times a week. He noted that if Sinegal's lower back pain did not get better "shortly," he would refer him to an orthopedic surgeon for "evaluation." Finally, Kathy Giovingo, a claims adjuster assigned to handle Sinegal's claim on behalf of Able Glass, testified that she received this medical report from Dr. Boustany on January 19, 1993.

On February 16, 1993, Giovingo acknowledged that she received notice from T. Michael Jordan, Sinegal's former attorney, that Sinegal was going to see Dr. Blanda to seek relief from the continuing pain in his lower back. At about the same time, Sinegal was examined by Dr. Shepherd, who recommended that he undergo a MRI and CT scan of his lower back. The MRI came back "normal," but the CT scan revealed that Sinegal had a "moderate degree of osteoarthritic changes of the facets at 5-1." Dr. Shepherd sent a medical report to Giovingo on March 10, 1993 in which he indicated that (1) Sinegal still complained of pain in his lower back; (2) there was apparent tenderness at the lower half of the lumbar musculature; (3) supine straight leg raise test caused severe pain at 10 degrees bilaterally; and (4) the Patrick's and Lasegue's tests caused moderate to severe pain at less than 25% completion bilaterally. Notwithstanding, Dr. Shepherd opined that Sinegal could be released from care "without any restrictions."

On March 18, 1993, Sinegal was examined by his orthopedic surgeon, Dr. Blanda. Dr. Blanda noted that Sinegal was still suffering from pain in his lower back area and opined that he should "undergo a more formal aggressive physical therapy program." Dr. Blanda placed Sinegal on orudus for pain, scheduled another appointment in 3 to 4 weeks, and noted that if there were no improvement, he would consider "other evaluation."

Giovingo testified that she terminated Sinegal's benefits on April 9, 1993 after she reviewed the medical reports of Drs. Boustany and Shepherd and the results of the MRI and CT scan. Giovingo admitted in the following testimony that she knew that Sinegal was being treated by Dr. Blanda at the time she terminated benefits but she made no effort to contact Dr. Blanda to obtain his reports and diagnosis:

Q. I believe you had testified earlier and in your deposition that Dr. Blanda's report of March 18, 1993 was not received in your office until June 25th, 1993, correct?
A. Yes, sir.
Q. Yet in March of 1993, even before Mr. Sinegal saw Dr. Blanda, you knew that he was seeing Dr. Blanda in March of 1993?
A. Yes, sir.
Q. Correct?
A. Yes, sir.
Q. At no time, between March 18th, 1993 and June 25th, 1993, did you or anybody else on your behalf correspond to Dr. Blanda to determine his opinion?
A. No, sir.
* * * * * *
Q. Instead, between March 18th, 1993, the date my client saw Dr. Blanda, his treating physician which you were aware of, and the date you received his report approximately three months later, no one at Able Glass Company did anything at all to determine the opinion of Dr. Louis Blanda?
*396 A. Not to my knowledge.

Clearly, Able Glass did not reasonably investigate to ascertain Sinegal's exact condition before his benefits were terminated. The record substantiates that throughout the relevant times, Sinegal was suffering from disabling symptoms.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Pitre v. Bessette Development Corp.
126 So. 3d 869 (Louisiana Court of Appeal, 2013)
Troy Pitre v. Bessette Development Corp.
Louisiana Court of Appeal, 2013
Baker v. Mazda Motor of America
856 So. 2d 118 (Louisiana Court of Appeal, 2003)
Bruce A. Baker v. Mazda Motor of America
Louisiana Court of Appeal, 2003
Roque v. Shell Beach Trucking
844 So. 2d 1111 (Louisiana Court of Appeal, 2003)
Villarreal v. Communications Systems Tech., Inc.
838 So. 2d 106 (Louisiana Court of Appeal, 2003)
Johnson v. Louisiana Container Co.
834 So. 2d 1052 (Louisiana Court of Appeal, 2002)
Burrell v. Evans Industries
761 So. 2d 618 (Louisiana Court of Appeal, 2000)
Faul v. Bonin
678 So. 2d 627 (Louisiana Court of Appeal, 1996)

Cite This Page — Counsel Stack

Bluebook (online)
663 So. 2d 393, 95 La.App. 3 Cir. 10, 1995 La. App. LEXIS 2655, 1995 WL 595790, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sinegal-v-able-glass-co-inc-lactapp-1995.