Tucker v. Security Industrial Insurance

865 So. 2d 998, 3 La.App. 3 Cir. 1011, 2004 La. App. LEXIS 135, 2004 WL 205822
CourtLouisiana Court of Appeal
DecidedFebruary 4, 2004
DocketNo. 03-1011
StatusPublished

This text of 865 So. 2d 998 (Tucker v. Security Industrial Insurance) 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
Tucker v. Security Industrial Insurance, 865 So. 2d 998, 3 La.App. 3 Cir. 1011, 2004 La. App. LEXIS 135, 2004 WL 205822 (La. Ct. App. 2004).

Opinion

hAMY, Judge.

In this workers’ compensation matter, the employee filed a disputed claim, contesting the termination of her medical benefits. The workers’ compensation judge determined that the employee-claimant did not meet the burden of proof of entitlement to such benefits. The written reasons for judgment submitted in the matter were not in conformity with the oral reasons as stated by the workers’ compensation judge, and the employee-claimant moved for a new trial in order that the written judgment might be amended. The motion was granted, and the workers’ compensation judge’s new written ruling stated that the employee-claimant had sustained a work-related injury and was entitled to medical benefits but was not entitled to disability benefits. The employer filed the instant appeal. For the following reasons, we affirm.

Factual and Procedural Background

Kathy Tucker, the claimant herein, was employed as a debit agent by Security Industrial Insurance. One of a debit agent’s duties, among other things, was to collect premiums from clients, which would often take place at clients’ homes in the evenings. On or around August 25, 1998, Ms. Tucker was collecting a premium payment at the home of a client who owned what was described as a very mean, territorial poodle. The record reflects that the client knew that Ms. Tucker was afraid of the dog; as such, it was not allowed to come into the house while Ms. Tucker was there. Upon the conclusion of business on this particular occasion, the client heard a door close. According to her testimony at the disputed-claim hearing in the matter, the client was under the impression that Ms. Tucker had gone, so she let the dog into the house. However, Ms. Tucker testified that she had not yet left the house and that it was actually the client’s husband who had closed a door. Ms. Tucker recalled that | ¡>she became extremely frightened when she realized that the dog was indoors. She testified that she turned and ran for her car, twisting something in the process. She noted that upon sitting in the driver’s seat, she experienced a burning, stabbing pain in her back and buttocks.

Two weeks later, on September 8, 1998, Ms. Tucker visited her family physician, complaining of back pain. On September 12 or 13, 1998, Ms. Tucker first mentioned the incident to a secretary in Security Industrial’s office and then to her supervisor, who instructed her to file a report with the district manager. The secretary testified at the disputed-claim hearing that company policy required that all accident reports were to be filed with the district manager immediately after the accident. Ms. Tucker reported the injury accordingly and ceased working for Security Industrial shortly thereafter. In April 1999, Ms. Tucker underwent back surgery, and in May 2002, surgery was performed on her neck.

Meanwhile, in November 2000, Ms. Tucker and her brother opened Pocket Money, a payday-loan business in Lake Charles. Ms. Tucker testified at the disputed-claim hearing that she did not manage or work in the business; although she would frequently remain at the store during operating hours at first, she would only write checks and pay the bills. Because of the severity of Ms. Tucker’s persistent back pain and discomfort, her father [1001]*1001brought a reeliner for her to use while she was at the store, and Ms. Tucker testified that she spent most of her time sitting in the reeliner, visiting with her employees.

Security Industrial paid Ms. Tucker’s workers’ compensation benefits from the time her injury was reported until February 1, 2001. The record indicates that the claims adjuster assigned to Ms. Tucker’s case learned of Pocket Money’s existence, J^and she initiated surveillance of Ms. Tucker’s activities. Video surveillance tapes made on four consecutive days in January 2001 showed Ms. Tucker unlocking Pocket Money’s doors in the morning and locking them at night. The claims adjuster testified at the disputed-elaim hearing that, in her opinion, the content of the tapes indicated that Ms. Tucker was able to work and that she had engaged in fraud for the purpose of obtaining workers’ compensation benefits, a violation of La. R.S. 23:1208, noting that she had not reported any earnings for January 2001. The claims adjuster terminated Ms. Tucker’s benefits accordingly.

Ms. Tucker filed a disputed claim against Security Industrial on March 6, 2001, contending that her benefits had been wrongfully terminated and that her recommended pain-management treatment had not been authorized. Security Industrial answered, arguing that Ms. Tucker did not sustain a work-related accident and that even if she had, she forfeited her right to such benefits when she did not claim income from working at Pocket Money and when she settled a third-party action without Security Industrial’s written consent.

The matter proceeded to hearing on October 14, 2002. In her oral reasons for ruling, the workers’ compensation judge concluded that the evidence presented was equally balanced in favor of both the claimant and the employer, and, consequently, Ms. Tucker did not meet the requisite burden of proving that her benefits were arbitrarily discontinued or that she was entitled to temporary or permanent disability benefits. The workers’ compensation judge further noted that, although Ms. Tucker was present at Pocket Money, her actions did not rise to the level of fraud that would warrant termination of benefits pursuant to La.R.S. 23:1208. However, the record reflects that the written ruling submitted by the employer and signed by the workers’ | ¿compensation judge on October 18, 2002, was not in conformity with the oral reasons issued in the matter. Instead, the written ruling states, inter alia, that Ms. Tucker did not prove that she sustained a work-related accident and, therefore, was not entitled to benefits.

Ms. Tucker filed a motion for new trial, seeking an amendment of the workers’ compensation judge’s written ruling to accurately reflect the rationale stated in the oral reasons. In this motion, Ms. Tucker noted that the workers’ compensation judge had not ruled that she did not suffer a work-related accident, as stated in the written ruling. The motion for new trial was granted on February 20, 2003. The workers’ compensation judge issued new written reasons for judgment on April 3, 2003, which stated that Ms. Tucker had suffered a work-related accident but was not entitled to disability benefits.

The employer appeals, asserting that the workers’ compensation judge erred in granting the employee’s motion for new trial and in finding that the employee sustained a work-related accident.

Discussion

Security Industrial’s argument on appeal is best addressed as two separate parts: first, that the workers’ compensation judge abused her discretion in granting Ms. Tucker’s motion for new trial; and second, that the workers’ compensation judge erred in determining that Ms. Tuck[1002]*1002er sustained a work-related accident. Accordingly, we examine these arguments in turn.

Motion for New Trial

Security Industrial contends on appeal that the workers’ compensation judge abused her discretion in granting Ms. Tucker’s motion for a new trial. It argues that |Kthe record supports the original judgment issued in this matter — namely, that Ms. Tucker failed to prove by a preponderance of the evidence that an at-work accident occurred.

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865 So. 2d 998, 3 La.App. 3 Cir. 1011, 2004 La. App. LEXIS 135, 2004 WL 205822, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tucker-v-security-industrial-insurance-lactapp-2004.