Tullier v. Ocean Accident & Guarantee Corp.

148 So. 2d 601, 243 La. 921, 1963 La. LEXIS 2174
CourtSupreme Court of Louisiana
DecidedJanuary 14, 1963
DocketNo. 46244
StatusPublished
Cited by7 cases

This text of 148 So. 2d 601 (Tullier v. Ocean Accident & Guarantee Corp.) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tullier v. Ocean Accident & Guarantee Corp., 148 So. 2d 601, 243 La. 921, 1963 La. LEXIS 2174 (La. 1963).

Opinion

SANDERS, Justice.

This workmen’s compensation proceeding presents for decision the single issue of whether statutory penalties and attorney’s fees should be assessed against the defendant insurance company, the unsuccessful litigant.

After trial, the district court rendered judgment in favor of the plaintiff for workmen’s compensation based on permanent and total disability, medical expenses in the sum of $11,716.00, a 12% statutory penalty on the accrued compensation and medical expenses, and attorney’s fees in the sum of $5,000.00. The Court of Appeal reduced the attorney’s fees to $3,000.00 and, as thus amended, affirmed the judgment of the district court.1 We granted certiorari to review the judgment of the Court of Appeal, limited to the question of penalties and attorney’s fees.

The plaintiff, Edward Tullier, was employed by Empire Machine Works, Inc. as a mechanic. On May 17, 1961, while driving his employer’s truck in the course and [603]*603scope of his employment, he collided with the rear of another vehicle. In the collision, Tullier was thrown against the steering wheel and received a blow in the region of his left chest. He was examined on the same day by Dr. James T. Reeves, physician and Coroner of Plaquemines Parish.The physician located the greatest point of tenderness over the seventh left rib on a line drawn from the middle of the armpit downward. Stethoscope examination of the heart was normal. After Tullier declined an X-ray for detection of fractured ribs, the physician prescribed a rib belt.

Tullier returned to work the next day. However, he was absent from work because of his injury from May 19 through May 29. X-rays revealed that he had a fracture of the seventh rib on his left side. He lost a total of 7Y¿ days from his employment. During this period he was treated by Dr. Reeves, but he also consulted Dr. E. F. Salerno. On May 29, Tullier informed Dr. Reeves that he felt sufficiently recovered to return to his employment. With the approval of the physician, he returned to work on May 30. However, his subsequent work was attended with complaints of pain in the region of his injury.

On July 2, 1961, Tullier suffered a heart attack while fishing for his own pleasure in a motor boat. Because of his serious condition, he was hospitalized. His condition was diagnosed as a myocardial infarction, the death of muscle fiber of the heart because of the lack of blood.

On or about August 1, 1961, the plaintiff retained an attorney to represent him in a claim for workmen’s compensation based on the heart attack. The attorney made demand on the defendant insurer asserting that the heart attack was caused by the accident of May 17. On August 2, 1961, without admitting liability for the heart attack, the defendant insurer transmitted a draft to plaintiff covering workmen’s compensation through July 23, 1961. However, the insurer declined to pay, at this time, the substantial medical and hospital expenses which had accrued after the heart attack. On August 17, the plaintiff instituted suit for. workmen’s compensation, medical expenses, penalties and attorney’s fees, based on alleged permanent and total disability arising from the heart attack.

The trial was commenced on October 13, 1961. The salient issue was whether the accidental injury of May 17 caused the heart attack of July 2. This issue has been finally resolved against the defendant.

The assessment of penalties and attorney’s fees in the instant case is governed by LSA-R.S. 22:658, which provides:

“All insurers issuing any type of contract other than those specified in R.S. 22:656 and 22:657 shall pay the amount of any claim due any insured including any employee under Chapter 10 of Title 23 of the Revised Statutes of 1950 within sixty days after receipt of satisfactory proofs of loss from the insured, employee or any party in interest. Failure to make such payment within sixty days after receipt of such proofs and demand therefor, when such failure is found to be arbitrary, capricious, or without probable cause, shall subject the insurer to a penalty, in addition to the amount of the loss, of 12% damages on the total amount of the loss, payable to the insured, or to any of said employees, together with all reasonable attorney’s fees for the prosecution and collection of such loss, or in the event a partial payment or tender has been made, 12% of the difference between the amount paid or tendered and the amount found to be due and all reasonable attorney’s fees for the prosecution and collection of such amount. * * * ”

Under the basic statute, it is clear that penalties arise only from an arbitrary and capricious refusal by the insurer to pay a just claim after sixty days notice of the [604]*604loss.2 The statute does not authorize the assessment of penalties merely because the insurer is the unsuccessful litigant.

In assessing penalties, the Court of Appeal held that the 60-day statutory period ran from May 17, 1961, the date of the truck accident. Finding no payment of workmen’s compensation after May 29, it concluded that the statutory period had elapsed prior to the filing of suit. As an additional basis for the imposition of penalties, the court adopted the view that the statutory period can be disregarded when the payments of compensation are not being currently made when suit is filed. The court held that under the circumstances the failure of the defendant insurance company to pay workmen’s compensation and medical expenses was arbitrary, capricious and without probable cause.

We cannot subscribe to this holding. In our opinion, the penalty period cannot be calculated from May 29, which was prior to the disabling heart attack. The record reflects that with the approval of the attending physician, the plaintiff had returned to his employment on May 30, and was so employed during the work week preceding the heart attack. Neither of the two physicians who had examined and treated him for his injury had detected any coronary disturbance or heart involvement. The defendant insurer was entitled to rely upon the medical findings of the attending physician during this period in the absence of conflicting medical information.

Substantially less than sixty days elapsed from the heart attack until the institution of suit. Approximately sixteen days elapsed from demand by plaintiff for compensation based on the heart attack until suit. Moreover, after demand, on August 2, the insurer delivered a draft to plaintiff for compensation through July 23. The Court of Appeal declined to consider this payment on the issue of penalties because the draft, although introduced in evidence, was not physically in the record on appeal. We find this to be error, for the delivery of this specific draft is admitted in plaintiff’s petition.

We note that the plaintiff contends that this draft and those subsequent to it did not constitute payments of workmen’s' compensation because they bore a notation indicating that they were for “temporary, total disability” during the designated period. The plaintiff, it is argued, was justified in refusing to accept these drafts because he could not cash them without prejudice to his claim that the disability was permanent. We must reject this contention. Under the workmen’s compensation law, no prejudice could have resulted. The contention is both without merit and foreclosed by the following joint stipulation entered by counsel at the trial:

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Bluebook (online)
148 So. 2d 601, 243 La. 921, 1963 La. LEXIS 2174, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tullier-v-ocean-accident-guarantee-corp-la-1963.