Smith v. Jitney Jungle of America

802 So. 2d 988, 2001 WL 1539929
CourtLouisiana Court of Appeal
DecidedDecember 5, 2001
Docket35,100-WCA
StatusPublished
Cited by11 cases

This text of 802 So. 2d 988 (Smith v. Jitney Jungle of America) 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
Smith v. Jitney Jungle of America, 802 So. 2d 988, 2001 WL 1539929 (La. Ct. App. 2001).

Opinion

802 So.2d 988 (2001)

Frank SMITH, Plaintiff-Appellee,
v.
JITNEY JUNGLE OF AMERICA, Crawford and Company and National Union Fire Insurance, Defendants-Appellants.

No. 35,100-WCA.

Court of Appeal of Louisiana, Second Circuit.

December 5, 2001.

*990 Adams and Reese LLP, by Richard B. Eason, II, Stefini Weckwerth Salles, New Orleans, Counsel for Appellants.

Cave Law Firm, by Renee Cooper Willis, Counsel for Appellee.

Before BROWN, WILLIAMS, CARAWAY, PEATROSS and KOSTELKA, JJ.

KOSTELKA, J.

Frank Smith ("Smith") was granted penalties and attorney fees by the Workers' Compensation Judge ("WCJ") who determined that Jitney Jungle of America and its insurer, National Union Fire Insurance (collectively, "the appellants"), had failed to timely pay various medical bills of Smith's. For the following reasons, we reverse in part and affirm in part the judgment of the WCJ.

FACTS

On December 15, 1995, while in the course and scope of his employment, Smith injured his back. As a result of the injury, Smith received medical treatment but has been unable to return to work and is receiving indemnity benefits from Crawford & Company, the third party administrator for the appellants.

Smith ultimately filed suit against the appellants claiming they were arbitrary and capricious for failing to timely pay six separate medical bills incurred by him as a result of his injury. The trial of the matter was scheduled for September 1, 2000 (after being continued twice), and on August 9, 2000, appellants filed their Motion for Leave to File Reconventional Demand and a Reconventional Demand, which were disallowed by the WCJ. On August 23, 2000, appellants also filed a Motion for Leave to File First Amended Reconventional Demand and a First Amended Reconventional Demand, which were also later denied by the WCJ.

The trial proceeded as scheduled, and after a full day of trial, the WCJ ruled that the appellants had been arbitrary and capricious in their handling of three medical bills incurred by Smith.[1] Those bills were: (1) $69.00 to Diagnostic Radiology Associates; (2) $92.54 to Vicksburg Medical Center; and (3) $80.00 to Dr. David Mecca ("Dr.Mecca"). Smith was awarded $2,000.00 in penalties and $5,000.00 in attorney fees for each of the first two medical bills and $500.00 in penalties and *991 $500.00 in attorney fees for the last medical bill, respectively. This appeal ensued regarding the final judgment of the WCJ. Also, appellants appeal the WCJ's refusal to allow their reconventional demands.

DISCUSSION

The Medical Bills

Appellants raise three separate assignments of error regarding the WCJ's findings on the three medical bills and the imposition of penalties and attorney fees.

Primarily, we note that pursuant to La. R.S. 23:1203(A), an "employer shall furnish all necessary drugs, supplies, hospital care and services, medical and surgical treatment, and any nonmedical treatment" related to a worker's work-related injury. However, this duty is limited "to the reimbursement determined to be the mean of the usual and customary charges for such care, services, treatment, drugs, and supplies, as determined under the reimbursement schedule annually published pursuant to R.S. 23:1034.2 or the actual charge made for the service, whichever is less." La. R.S. 23:1203(B). Such medical benefits are required to be paid within sixty days after the employer or insurer receives written notice of the charges, with failure to do so resulting in the imposition of penalties and reasonable attorney fees. La. R.S. 23:1201(E) and (F). However, such penalties and attorney fees will not be imposed if nonpayment results from conditions over which the employer or insurer had no control. La. R.S. 23:1201(F)(2).

However, a claimant is not without duty himself. The worker claiming medical benefits must prove by a preponderance of the evidence the necessity and relationship of the treatment to the work-related accident. Shields v. GNB Technologies, Inc., 33,911 (La.App.2d Cir.10/04/00), 768 So.2d 774, 780, citing, Chitman v. Davison Trucking, 28,073 (La.App.2d Cir.02/28/96), 669 So.2d 671. Additionally, "In order to recover medical expenses under Sec. 1203, the claimant must prove that the expenses are reasonably necessary for treatment of a medical condition caused by the work injury...." Shields, 768 So.2d at 780, citing Whittington v. Rimcor, Inc., 601 So.2d 324, 329 (La.App. 2d Cir.1992), writ denied, 605 So.2d 1366 (La.1992).

Finally, we review the WCJ's award of attorney fees and penalties under the manifest error standard. Kelley v. Jack Jackson Const. Co., 32,663 (La. App.2d Cir.12/30/99), 748 So.2d 1270, citing, Banks v. Industrial Roofing & Sheet Metal Works, Inc., 96-2840 (La.07/01/97), 696 So.2d 551; Oliveaux v. Riverside Nursing Home, 29,419 (La.App.2d Cir.04/02/97), 691 So.2d 340.

Diagnostic Radiology Associates bill

Appellants' first assignment of error addresses the WCJ's finding that they acted arbitrarily and capriciously by failing to timely pay a bill for $69.00 to Diagnostic Radiology Associates. As a result, the appellants were assessed $2,000.00 in penalties and $5,000.00 in attorney fees, which finding we conclude was in error for the following reasons.

On April 27, 1998, counsel for Smith sent the first request to Crawford & Company requesting payment of the $69.00 bill from Diagnostic Radiology Associates. The bill reflected a date of treatment of January 21, 1997 with a brief description of the service provided; however, there was no indication that the treatment was related to Smith's on-the-job accident. In fact, the space labeled "injury date" was left blank. On June 1, 1998, Smith's counsel sent a second letter to Crawford & Company, requesting that "If payment is being denied, please forward your reason for denying *992 same to my office within the next 15 days." (Emphasis added.) Attached to the letter was a "final notice" statement from Diagnostic Radiology Associates stating the account number and amount due. Requests for payment were also made on August 18, 1998 and September 4, 1998. Penny Crawford, an adjuster for Crawford & Company, admitted at trial receiving all such letters.

On October 6, 1998, Smith's attorney sent a letter to Diagnostic Radiology Associates regarding the bill, noting that "Your notice does not reference a date of service, but I am assuming that any treatment rendered to Mr. Smith resulted from the injuries he sustained while in the course and scope of his employment with Jitney Jungle." She further stated that "workers' compensation payments are based on a fee schedule set forth by state law. If the amount due is the balance after the insurance carrier has paid your company pursuant to the fee schedule, you are not able to seek the balance from my client, Frank Smith."

First, considered on their face, the invoices sent to Crawford & Company, bore insufficient information to indicate that the treatment was necessary and related to Smith's workplace injury. The record does not reflect that Diagnostic Radiology Associates had provided treatment before nor does it appear that Smith had been treated previously at "River Oaks Hospital," which the invoice lists as the "location of service." Smith's attorney's October 6th letter to Diagnostic Radiology Associates shows her own uncertainty as to the relatedness, as she was merely "assuming" the relatedness of the treatment to the injury.

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Bluebook (online)
802 So. 2d 988, 2001 WL 1539929, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-jitney-jungle-of-america-lactapp-2001.