Starks v. Universal Life Ins. Co.

666 So. 2d 387, 95 La.App. 1 Cir. 1003, 1995 La. App. LEXIS 3569, 1995 WL 743592
CourtLouisiana Court of Appeal
DecidedDecember 15, 1995
Docket95 CA 1003
StatusPublished
Cited by19 cases

This text of 666 So. 2d 387 (Starks v. Universal Life Ins. Co.) 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
Starks v. Universal Life Ins. Co., 666 So. 2d 387, 95 La.App. 1 Cir. 1003, 1995 La. App. LEXIS 3569, 1995 WL 743592 (La. Ct. App. 1995).

Opinion

666 So.2d 387 (1995)

Thelma Robyn STARKS
v.
UNIVERSAL LIFE INSURANCE COMPANY.

No. 95 CA 1003.

Court of Appeal of Louisiana, First Circuit.

December 15, 1995.
Writ Denied March 8, 1996.

*389 Anthony P. Lewis, Thibodaux, for Plaintiff/Appellant, Thelma Robyn Starks.

Lynn L. Lightfoot, New Orleans, for Defendant/Appellee, Universal Life Insurance Company.

Before CARTER and PITCHER, JJ., and CRAIN[1], J. Pro Tem.

CARTER, Judge.

This is an appeal from a judgment of the Office of Workers' Compensation.

FACTS

On January 29, 1992, Thelma R. Starks, plaintiff, who was employed as an insurance collector for Universal Life Insurance Company (Universal), slipped and fell on the porch of a client and landed on her buttocks. As a result of the fall, plaintiff sustained injuries to her back, legs, and shoulder. Plaintiff was paid workers' compensation benefits from the date of the accident through October 21, 1992.

In May, 1994, Dr. Dexter Gary found that plaintiff had a central disc protrusion at the L-5 level. He, therefore, recommended that plaintiff undergo a discectomy, but Universal did not approve payment for the surgery.

On June 21, 1994, plaintiff filed a Disputed Claim for Compensation (1008 form) with the Office of Workers' Compensation, seeking weekly compensation benefits and medical benefits for payment of the surgery. Universal answered, alleging that plaintiff's claim for weekly compensation benefits had prescribed and, alternatively, that plaintiff was not disabled.

On January 13, 1995, trial on the merits was held. At the trial, the parties entered into the following stipulations:

(1) Plaintiff's average weekly wage at the time of the accident was $320.23 with the corresponding Louisiana Workers' Compensation Rate of $213.59.
(2) Plaintiff has been paid compensation benefits from January 29, 1992, until October 21, 1992, for the total of $7,409.95 in weekly compensation benefits.
(3) The total amount of medical benefits that have been paid by plaintiff's employer to date is $8,012.61.
(4) Plaintiff was in the course and scope of her employment with Universal Life Insurance Company on January 29, 1992.

On January 24, 1995, the hearing officer rendered judgment in favor of Universal. The hearing officer found that plaintiff's claim for weekly compensation benefits had prescribed, that plaintiff was not entitled to temporary total disability benefits, and that Universal was not arbitrary and capricious in denying plaintiff benefits. Plaintiff was ordered to pay all costs of the proceedings, and her claims against Universal were dismissed with prejudice. Plaintiff appealed from this adverse judgment, assigning the following specifications of error:

(1) The hearing officer erred in finding that plaintiff's claim for workers' compensation had prescribed.
(2) The hearing officer erred in finding that plaintiff was not entitled to temporary total disability benefits.
(3) The hearing officer erred in finding that defendant, Universal Life Insurance Company, was not arbitrary and capricious.
(4) The hearing officer erred in dismissing plaintiff's motion to appeal his ruling in forma pauperis.

PRESCRIPTION OF CLAIM FOR COMPENSATION BENEFITS

A. Claim for Weekly Compensation Benefits

Prescription of a claim for workers' compensation benefits is addressed in LSA-R.S. 23:1209 A, which provides as follows:

In case of personal injury, including death resulting therefrom, all claims for *390 payments shall be forever barred unless within one year after the accident or death the parties have agreed upon the payments to be made under this Chapter, or unless within one year after the accident a formal claim has been filed as provided in Subsection B of this Section and in this Chapter. Where such payments have been made in any case, the limitation shall not take effect until the expiration of one year from the time of making the last payment, except that in cases of benefits payable pursuant to R.S. 23:1221(3) this limitation shall not take effect until three years from the time of making the last payment of benefits pursuant to R.S. 23:1221(1), (2), (3), or (4). Also, when the injury does not result at the time of, or develop immediately after the accident, the limitation shall not take effect until expiration of one year from the time the injury develops, but in all such cases the claim for payment shall be forever barred unless the proceedings have been begun within two years from the date of the accident. (Footnote omitted). (Emphasis added).

Development of the injury has been equated in the jurisprudence with development of the disability. Holmes v. Baton Rouge Water Works Company, 558 So.2d 629, 631 (La. App. 1st Cir.1990). Disability marks the time from which it is clear that the employee is no longer able to perform the duties of his employment in a satisfactory manner. Swearingen v. Air Products & Chemical, Inc., 481 So.2d 122, 124 (La.1986). LSA-R.S. 23:1209 B requires that a claim for a developing disability be instituted within two years from the date of the accident that causes the developing disability. Lynn v. Berg Mechanical, Inc., 582 So.2d 902, 910 (La.App. 2nd Cir.1991).

In the instant case, Universal paid plaintiff weekly compensation benefits until October 21, 1992. According to LSA-R.S. 23:1209 A, plaintiff had one year from that last payment, or until October 21, 1993, to timely file a claim for weekly compensation benefits. Plaintiff's claim was not instituted until June 21, 1994, at which time her claim had prescribed.

However, plaintiff seeks to invoke the developmental theory set forth in the last sentence of LSA-R.S. 23:1209 A to show that her claim had not prescribed. Plaintiff argues that, although she knew that she had a disc problem prior to the one-year prescription date, it was not made clear to her until May of 1994 that surgery was needed. Based on the developmental theory, plaintiff contends that her claim would not have prescribed until May of 1995, one year from the discovery of her injury and, thus, her claim was timely filed in June of 1994. However, the statute clearly provides that the developmental theory cannot be applied unless the claim is filed within two years of the date of the accident. In this case, because plaintiff's claim was not filed within two years of the date of the accident, the developmental theory is inapplicable. See Lynn v. Berg Mechanical, Inc., 582 So.2d at 910. The hearing officer correctly determined that plaintiff's claim for weekly compensation benefits had prescribed.

B. Claim for Medical Benefits

Prescription of claims for medical benefits is addressed in LSA-R.S. 23:1209 C, which provides as follows:

All claims for medical benefits payable pursuant to R.S. 23:1203 shall be forever barred unless within one year after the accident or death the parties have agreed upon the payments to be made under this Chapter, or unless within one year after the accident a formal claim has been filed with the office as provided in this Chapter. Where such payments have been made in any case, this limitation shall not take effect until the expiration of three years from the time of making the last payment of medical benefits.

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Bluebook (online)
666 So. 2d 387, 95 La.App. 1 Cir. 1003, 1995 La. App. LEXIS 3569, 1995 WL 743592, Counsel Stack Legal Research, https://law.counselstack.com/opinion/starks-v-universal-life-ins-co-lactapp-1995.