Spikes v. Louisiana Commerce & Trade Ass'n

161 So. 3d 755, 13 La.App. 1 Cir. 919, 2014 WL 2958449, 2014 La. App. LEXIS 1701
CourtLouisiana Court of Appeal
DecidedJuly 2, 2014
DocketNo. 13-919
StatusPublished
Cited by6 cases

This text of 161 So. 3d 755 (Spikes v. Louisiana Commerce & Trade Ass'n) 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
Spikes v. Louisiana Commerce & Trade Ass'n, 161 So. 3d 755, 13 La.App. 1 Cir. 919, 2014 WL 2958449, 2014 La. App. LEXIS 1701 (La. Ct. App. 2014).

Opinion

PICKETT, Judge.

LA workers’ compensation claimant appeals a judgment rendered that denies her claims for medical treatment, penalties, and attorney fees. The claimant’s employer and its workers’ compensation insurer answer the appeal and assign errors. Finding no errors, we affirm the judgment in all respects and deny the relief sought on appeal.

FACTS

On February 25, 2008, Janice Spikes injured her back in the course and scope of her employment with Tri-Parish Rehabilitation Hospital, LLC d/b/a Rehabilitation Hospital of Dequincy. She underwent a bilateral lumbar laminectomy at L3-4 by Dr. Clark Gunderson in July 2011. Dr. Gunderson referred Ms. Spikes to psychologist James W. Quillin in August 2011 to help her adjust to pain she continued to suffer after the surgery.

In January and June 2012, Dr. Quillin submitted requests to her employer’s insurer, Louisiana Commerce and Trade Association Self Insurer’s Fund (LCTASIF), for treatment in the forms of biofeedback, group psychotherapy, psychological testing, and individual psychotherapy to address Ms. Spikes’ pain syndrome. LCTA-SIF denied the requested treatment. He then filed Disputed Claims for Medical Treatment with the Office of Workers’ Compensation Administration Medical Services (Medical Services), appealing the de[758]*758nied treatment. Medical Services denied the appeals.

Dr. Quillin also recommended that Ms. Spikes see a pain management specialist. Ms. Spikes scheduled an appointment with Dr. Michael Dole, a pain management specialist, but the defendants would not approve payment for the appointment.

pin March 2012, Ms. Spikes filed a Disputed Claim for Compensation against the defendants, asserting bona fide disputes existed concerning: 1) the medical treatment recommended by Dr. Quillin; 2) referral to a pain management specialist; 3) failure to authorize treatment; and 4) penalties, attorney fees, court costs, and expenses. Thereafter, Dr. Gunderson sought approval from the defendants for a referral of Ms. Spikes to pain management specialist, Dr. Stephen Katz, for one visit, which was denied. Dr. Gunderson appealed the denial to Medical Services; his appeal was denied.

The defendants filed an exception of no cause of action regarding Ms. Spikes’ claim that pursuant to La.R.S. 23:1121(B), she has the right to consultation with a pain management specialist regardless of whether La.R.S. 23:1203.1 and the MTG apply to her request.

At trial, Ms. Spikes argued La.R.S. 23:1203.1 and the Medical Treatment Guidelines (MTG)1 do not apply to her claims because she was injured prior to the adoption of the statute. She also asserted the defendants’ denial of her claims was arbitrary and capricious and sought penalties and attorney fees. Alternatively, Ms. Spikes asserted that if La.R.S. 23:1203.1 was deemed applicable to her claims, the clear and convincing standard of review provided in Section K2 of the statute |sdoes not apply because Medical Services’ reviews of her claims were not performed by the medical director as provided in Section J(l) of the statute.

The workers’ compensation judge (WCJ) issued a Judgment which held that the decisions issued by Medical Services that were rendered by a physician other than the medical director did not comply with the provisions of the MTG and that the denial of Ms. Spikes’ request for a consultation with Dr. Katz was “inappropriate.” The WCJ’s Judgment did not address Ms. Spikes’ other claims or the defendants’ exception of no cause of action.

Ms. Spikes appealed the Judgment. On appeal, she assigns four errors with the Judgment and requests attorney fees for work performed on appeal. The defendants answered the appeal and assign five errors with the Judgment.

ASSIGNMENT OF ERRORS
Ms. Spikes assigns the following errors: 1. The trial court’s judgment is silent as to the issue regarding medical treatment with psychologist Dr. Quillin; therefore, it is presumed to have been rejected by the trial court. The trial court erred in not ordering defendants to authorize medical treatment with Dr. Quillin, in particular, Behavioral Pain [759]*759Management (group therapy, coping skills, biofeedback-peripheral blood flow, biofeedback-SEM’G directed to specific sight of pain) with psychologist Dr. Quil-lin and psychological testing (MPI and MMPI tests), and psychotherapy post treatment follow-up as recommended by Dr. Quillin.
2. The trial court judgment is silent as to Janice Spikes’ request for penalties and attorney[ ] fees; therefore, it is presumed to have been rejected by the trial court. The trial court erred in- not awarding penalty and attorney[] fees for defendants’ refusal to authorize medical benefits with her choice of pain management and psychological treatment recommended by Dr. Quillin.
3. The trial court’s judgment is silent as to Janice Spikes’ request for costs; therefore, it is presumed to have been rejected by the trial court. The trial court erred in not awarding Janice Spikes’ costs.
4. [La.R.S. 23:1203.1] is substantive in nature and therefore it applies prospectively only.

|4The defendants assign the following errors with the WCJ’s judgment:

1. The Office of Workers’ Compensation failed to rule on the appeals of the medical director’s decisions and should have denied the request for treatment recommended by Dr. Quillin.
2. The Office of Workers’ Compensation erred in overruling appellees’ objections to the admissibility of evidence not submitted to the medical director.
3. The Office of Workers’ Compensation erred in not taxing as costs payable by the appellant expenses associated with the depositions of Dr. Fenn3 and Dr. Datz.
4. The Office of Workers’ Compensation erred in not denying outright the claims for penalties and attorney[ ] fees sought by the appellant.
5. The Office of Workers’ Compensation erred in denying appellees’ exception of no cause of action to the appellant’s request for choice for approval of choice of physician.

DISCUSSION

Central to this appeal is whether La.R.S. 23:1203.1 applies to claims for medical treatment submitted by claimants who were injured before the statute became effective. Because cases pending before the Louisiana Supreme Court presented the same issue when this appeal was lodged, we issued a Stay Order in this matter on January 27, 2014, staying the appeal until the supreme court decided those cases. Spikes v. Louisiana Commerce & Trade Ass’n Tri-Parish Rehab. Hosp., LLC d/b/a Rehab. Hosp. of Dequincy, 13-919 (La.App. 3 Cir. 1/27/14) (unpublished order). In Church Mutual Insurance Co. v. Dardar, 13-2351, p. 13 (La.5/7/14), 145 So.3d 271, 283, 2014 WL 1800067, the supreme court determined that “La.R.S. 23:1203.1 is a procedural vehicle ... for enforcing a substantive right ... [and] does not impinge on or lessen the substantive right to necessary medical treatment conferred by La.R.S. 23:1203.” Section 1203.1 is procedural in nature; | therefore, it “applies prospectively to all requests for medical treatment and/or disputes arising out of requests for medical treatment arising after the effective date of La.R.S.

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Cite This Page — Counsel Stack

Bluebook (online)
161 So. 3d 755, 13 La.App. 1 Cir. 919, 2014 WL 2958449, 2014 La. App. LEXIS 1701, Counsel Stack Legal Research, https://law.counselstack.com/opinion/spikes-v-louisiana-commerce-trade-assn-lactapp-2014.