Taylor v. State, Department of Public Safety & Corrections

814 So. 2d 64, 2001 La.App. 1 Cir. 0348, 2002 La. App. LEXIS 906, 2002 WL 468111
Louisiana Court of Appeal·Decided March 28, 2002·No. No. 2001 CA 0348·Published·Cited by 1 cases

Opinion

[JAN W. CLAIBORNE, Judge Pro Tern.

Plaintiff, Benny Taylor (Taylor), filed a claim for workers’ compensation benefits against his employer, the State of Louisiana Department of Public Safety and Corrections (the State). He alleged that the State was liable for medical bills he incurred during the course and scope of his training as a Louisiana state trooper in May of 1999. The adjuster with the Louisiana Office of Risk Management denied the claim. After a hearing, the Workers’ Compensation judge (WCJ), Judge Pamela Moses-Laramore, of District 5 of the Office of Workers’ Compensation Administration,2 rendered judgment in favor of Taylor and ordered the State to pay all medical bills, but denied Taylor’s claims for penalties and attorney fees. Taylor appealed, claiming that the WCJ was manifestly erroneous in denying his claims for penalties and attorney fees. The State also appealed, claiming that the WCJ’s ruling that the State pay Taylor’s medical bills was erroneous.

BACKGROUND

On May 2, 1999, Taylor was a state police trainee with the Louisiana Department of Public Safety and Corrections. While running during the course of his training, Taylor had chest pains. He was taken to a hospital, where he was admitted, and tests were conducted. After a few days, Taylor was released, and he returned to the training academy. He completed his training and is now a state trooper.

Taylor made a workers’ compensation claim for payment of his medical bills. The State denied the claim and refused to pay the medical bills on the basis that Taylor’s chest pains were not covered under the workers’ compensation act. The State concluded that there was “no clear and convincing evidence that the ^physical work stress was extraordinary and unusual in comparison to the stress experienced by the average employee in [Taylor’s] occupation” as required under the workers’ compensation act for heart-related injuries. Subsequently, Taylor’s attorney sent a let[66]*66ter to the State contesting this decision. The State again denied the claims.

At the trial, Louisiana Office of Risk Management adjuster, Catherine Bourdet, testified that the medical records related to the claim, including the report of the cardiologist, were reviewed before the claim was rejected. She also indicated that during a telephone conversation with Taylor, he indicated that he had experienced diarrhea and vomiting the weekend before he suffered the chest pains. Her office initially concluded that Taylor’s condition was heart-related or a perivascular problem and rejected the claim. After Taylor’s attorney sent a letter on behalf of his client, Ms. Bourdet’s office concluded that the flu and a preexisting heart condition was the basis for Taylor’s pains. She further testified that the subsequent denial was based on the determination that there was no accident and no injury which occurred as a result of an accident.

Taylor testified that he was aware he has a congenital heart murmur. He denied having chest pains in the past from exertional activity. Nor did health problems prevent him from entering the Coast Guard or the state police academy. Taylor explained that the running pace in his training was faster than the pace he was used to. When he returned home on a Friday after weeklong training, he had diarrhea, fever and chills. He took Imodium for the diarrhea and his symptoms disappeared before he returned to the academy on Sunday afternoon. Despite the medical history recorded in the emergency room records, Taylor denied he told doctors at the hospital that he had prior chest pains. Taylor’s wife, Darleen, testified that she had never heard her husband complain of chest pains.

I/The WCJ found that there was an unexpected, unforeseen and identifiable precipitous event (accident) under the statute. The WCJ also concluded that based upon the doctor’s reports, including the cardiologist’s report, “the exertion and the dehydration is the actual true and end-all diagnosis and cause.”

As to the claim for penalties and attorney fees, the WCJ ruled that the State was not unreasonable in denying the claims. The WCJ indicated that there were statements, including those by Taylor to the treating physicians, in the medical reports which “would raise questions in the mind of any adjuster.” The judge also stated that because “all of these tests were done on a cardiovascular situation or to rule out cardiovascular situation,” there could have been more than one interpretation of the exhibits and facts.

MEDICAL EXPENSES

The State argues that the WCJ erred in finding that an accident (unusual or precipitous event) occurred.

An employer has a statutory duty to furnish all necessary medical treatment caused by a work-related injury. La. R.S. 23:1203(A). The right to reimbursement for medical expenses is separate and distinct from the right to compensation. Whether the claimant is entitled to medical benefits is a factual question, the resolution of which may not be disturbed by the appellate court in the absence of manifest error or unless clearly wrong. Parfait v. Gulf Island Fabrication, Inc., 97-2104, p. 9 (La.App. 1st Cir.1/6/99), 733 So.2d 11, 19.

To recover medical expenses under La. R.S. 23:1203, the claimant must prove by a preponderance of the evidence that the expenses are reasonably necessary for treatment of a medical condition caused by the work injury. An award of medical expenses must be limited to those expenses shown to have been made neces[67]*67sary by the work-related accident. An injured employee is not entitled | sto recover for medical expenses where he or she fails to substantiate a claim. Parfait, 97-2104 at 9, 733 So.2d at 19-20.

La. R.S. 23:1031(A) provides that an employer is liable to pay compensation for an employee’s “personal injury by accident arising out of and in the course of his employment.” La. R.S. 23:1021 defines the following terms, in pertinent part:

(1) “Accident” means an unexpected or unforeseen actual, identifiable, precipitous event happening suddenly or violently, with or without human fault, and directly producing at the time objective findings of an injury which is more than simply a gradual deterioration or progressive degeneration.
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(7) (a) “Injury” and “personal injuries” include only injuries by violence to the physical structure of the body and such disease or infections as naturally result therefrom. These terms shall in no case be construed to include any other form of disease or derangement, however caused or contracted.
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(e) Heart-related or perivascular injuries. A heart-related or perivascular injury, illness, or death shall not be considered a personal injury by accident arising out of and in the course of employment and is not compensable pursuant to this Chapter unless it is demonstrated by clear and convincing evidence that:
(i) The physical work stress was extraordinary and unusual in comparison to the stress or exertion experienced by the average employee in that occupation, and
(ii) The physical work stress or exertion, and not some other source of stress or preexisting condition, was the predominant and major cause of the heart-related or perivascular injury, illness, or death.

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Taylor v. State, Department of Public Safety & Corrections, 814 So. 2d 64, 2001 La.App. 1 Cir. 0348, 2002 La. App. LEXIS 906, 2002 WL 468111 (La. Ct. App. 2002).

814 So. 2d 64 (Taylor v. State, Department of Public Safety & Corrections) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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