Smith v. Morris & Dickson

924 So. 2d 1217, 2006 WL 475306
CourtLouisiana Court of Appeal
DecidedMarch 1, 2006
DocketWCA 2005-1120
StatusPublished
Cited by5 cases

This text of 924 So. 2d 1217 (Smith v. Morris & Dickson) 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. Morris & Dickson, 924 So. 2d 1217, 2006 WL 475306 (La. Ct. App. 2006).

Opinion

924 So.2d 1217 (2006)

Shelby SMITH
v.
MORRIS & DICKSON.

No. WCA 2005-1120.

Court of Appeal of Louisiana, Third Circuit.

March 1, 2006.

*1218 Linda Lea Smith Blackman, Bossier City, LA, for Defendants/Appellants Morris & Dickson Louisiana Retailers Mutual Insurance Company.

W. Jay Luneau, Luneau Law Office, Alexandria, LA, for Plaintiff/Appellee Shelby Smith.

Court composed of SYLVIA R. COOKS, BILLY HOWARD EZELL, and JAMES T. GENOVESE, Judges.

*1219 EZELL, Judge.

This workers' compensation case presents the issue of awards of penalties and attorney fees based on three separate incidents. Morris & Dickson and its insurer, Louisiana Retailers Mutual Insurance Company, appeal a judgment awarding penalties and attorney fees to Shelby Smith on the issues of choice of physician, failure to reasonably controvert a request for knee replacement surgery, and failure to reasonably controvert payment of a medical bill.

FACTS

Shelby Smith worked for Morris & Dickson for fifteen years as a driver delivering pharmaceutical supplies when he was injured on September 19, 2002. While he was making a delivery to a pharmacy, Mr. Smith tripped and fell as he was pulling a load of supplies, injuring his right knee.

Morris & Dickson sent Mr. Smith to Dr. Robert Smith, a general practitioner at Rapides Industrial Medicine Clinic. Dr. Smith referred Mr. Smith to Dr. Douglas Gamburg at the Orthopedic and Sports Medicine Specialists Clinic. Dr. Gamburg opined that Mr. Smith needed surgery. Since Dr. Gamburg no longer performed surgery, he referred Mr. Smith to Dr. Jeffrey Garrison, another orthopedic surgeon in the same clinic.

Dr. Garrison recommended arthroscopic surgery which was performed in April 2003. Following the surgery, Mr. Smith's condition failed to improve. He continued to have difficulty with weight-bearing activities due to the condition of his right knee. Dr. Garrison opined that Mr. Smith had "suffered a work-related injury that exacerbated and aggravated a most likely underlying chronic arthritic condition that was asymptomatic." Dr. Garrison further believed the arthritic condition was worsened with the meniscus tear and injury to his knee joint surface, resulting in a severely symptomatic state. It was Dr. Garrison's recommendation that Mr. Smith have knee replacement surgery.

Phil Moory, a special investigative adjustor with Summit who was handling the claim, requested a second opinion regarding Mr. Smith's need for knee replacement surgery on September 19, 2003. Dr. Matthew Vuskovich, an occupational medicine specialist who never examined Mr. Smith, determined that Mr. Smith's present symptoms were caused by preexisting chondromalacia and complications of insulin dependant diabetes mellitus. He further stated that, due to age and chronic diseases including coronary heart disease and diabetes, Mr. Smith had increased odds for serious surgical complications including infection, deep vein thrombosis, and pulmonary embolus. Dr. Vuskovich opined that total replacement of the right knee was not medically necessary.

Morris & Dickson refused to authorize the surgery after several requests for approval. As a result of the refusal, Mr. Smith, through counsel, wrote a letter dated October 7, 2003, requesting his choice of physician, Dr. Terry Texada, be approved. Formal demand was also made by Mr. Smith who filed a claim with the Office of Workers' Compensation on October 6, 2003.

On December 16, 2003, Mr. Smith filed a rule to show cause requesting a hearing on the approval of his evaluation with Dr. Texada. Subsequently, Morris & Dickson filed a motion for expedited hearing in which it sought an order compelling the employee to attend an examination with Dr. Gordon Mead. These two matters were consolidated, and a hearing on the rule was held on January 13, 2004. At the hearing, Morris & Dickson substituted Dr. David D. Waddell for Dr. Mead as the *1220 orthopedist it sought to have examine the employee.

The workers' compensation judge (WCJ) ruled that Dr. Garrison was the employer's choice of physician and denied the employer's motion seeking to have the employee examined by another doctor of Morris & Dickson's choosing. Additionally, the WCJ ruled that Dr. Garrison was not the employee's choice of physician; therefore, Mr. Smith could be seen by an orthopedist of his own choosing, Dr. Texada. Judgment was signed on February 2, 2004, and Morris & Dickson sought a writ of review with this court. This court denied the writ in an unpublished ruling. Smith v. Morris & Dickson, WCW 04-381 (La.App. 3 Cir. 6/24/04). Morris & Dickson then sought a writ of review with the supreme court, which was also denied. Smith v. Morris & Dickson, 04-1880 (La.10/29/04), 885 So.2d 594.

On March 11, 2005, Mr. Smith filed a motion to amend his petition to add a claim that Morris & Dickson had failed to pay a bill submitted by Cenla Heart Specialists for conducting a pre-operative clearance examination prior to his approved knee surgery. He asked for penalties and attorney fees for the refusal to pay this bill.

A hearing on the issue of penalties and attorney fees was held on April 8, 2005. On June 22, 2005, the WCJ held that Morris & Dickson was unreasonable in its denial of Dr. Texada as Mr. Smith's choice of physician and awarded a $2,000 penalty and $3,500 in attorney fees. The court awarded an additional $2,000 penalty and $7,000 in attorney fees, finding that Morris & Dickson failed to promptly provide knee replacement surgery. Finally, the WCJ also ruled that Morris & Dickson failed to promptly pay the Cenla Heart Specialists bill and awarded a $2,000 penalty and $2,500 in attorney fees.

A judgment was signed on July 14, 2005. Morris & Dickson and its insurer appealed the judgment on all three penalty and attorney fees awards. Mr. Smith answered the appeal asking for additional attorney fees for work necessitated by this appeal.

Since all issues in this appeal surround the WCJ's award of penalties and attorney fees, we are mindful that WCJ's determination of whether an employer or insurer should be cast with penalties and attorney fees in a workers' compensation case is question of fact subject to the manifest error/clearly wrong standard of review. Authement v. Shappert Eng'g, 02-1631 (La.2/25/03), 840 So.2d 1181.

CHOICE OF PHYSICIAN

Morris & Dickson claims that it was reasonable in failing to grant Mr. Smith's request to see Dr. Texada. It argues that the law surrounding choice of physician issues was in a state of confusion at the time. It cites 2003 La. Acts No. 886, § 1 which amended La.R.S. 23:1121 by adding Sections B(2) through B(5) and was effective August 15, 2003, less than two months before Mr. Smith filed his claim. Morris & Dickson argue that the effect of this amendment was unknown until this court rendered its decision in Messina v. Isle of Capri Casino, 04-1061 (La.App. 3 Cir. 12/22/04), 891 So.2d 780, writ denied, 05-535 (La.4/29/05), 901 So.2d 1071. In Messina, this court held that the amendment was substantive in nature since it changed the rules for selecting a physician and, therefore, it should be only applied prospectively.

Sections B(2) through B(5) of La.R.S. 23:1121 as added by the legislature in 2003 provide:

(2)(a) If the employee is treated by any physician to whom he is not specifically directed by the employer or insurer, *1221

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Cite This Page — Counsel Stack

Bluebook (online)
924 So. 2d 1217, 2006 WL 475306, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-morris-dickson-lactapp-2006.