Tyler v. Rockwood Insurance Co.

690 So. 2d 834, 96 La.App. 1 Cir. 0326, 1997 La. App. LEXIS 410, 1997 WL 77860
CourtLouisiana Court of Appeal
DecidedFebruary 14, 1997
DocketNo. 96 CA 0326
StatusPublished
Cited by3 cases

This text of 690 So. 2d 834 (Tyler v. Rockwood Insurance 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
Tyler v. Rockwood Insurance Co., 690 So. 2d 834, 96 La.App. 1 Cir. 0326, 1997 La. App. LEXIS 410, 1997 WL 77860 (La. Ct. App. 1997).

Opinion

I2PARRO, Judge.

This is a workers’ compensation action in which an employee, Whitney Tyler (“Tyler”), sought to recover benefits for total disability, medical expenses, attorney’s fees and penalties as a result of injuries suffered while in the course and scope of his employment with Harvey Hyland, Inc. (“Harvey”). The trial court ruled in favor of Tyler, awarding supplemental earnings benefits (“SEB”) and certain medical expenses. From this judgment, Tyler appealed, and Harvey and its insurer filed an answer to his appeal. For the following reasons, we affirm.

Facts and Procedural History

Tyler was employed by Harvey as a supervisor of manual laborers who moved office furniture. On January 18, 1989, while lifting a heavy steel desk which was to be loaded onto a truck, Tyler felt a severe and sudden pain in his back. On January 31,1989, Tyler saw Dr. Thomas Flynn, a neurosurgeon, [836]*836whose diagnosis was a recurrent disc rupture. Dr. Flynn performed surgery on February 21, 1989, and treated Tyler on a regular basis until November 6, 1989, when he discharged Tyler and released him to return to his usual and ordinary occupation.

Because of this injury, Harvey’s insurer, Rockwood Insurance Company (“Rock-wood”), paid full workers’ compensation benefits for temporary total disability in the amount of $175 per week to Tyler from the time of his injury until June 14, 1989, from July 25, 1989, through September 5, 1989, and from November 18,1989, through March 2, 1990. During the interim periods and after March 2, 1990, defendants paid Tyler SEB in the amount of $752.50 per month. SEB payments were ongoing at the time of trial.

Tyler filed a suit against Harvey and Rockwood in district court on February 20, 1990, at a time when they were allegedly refusing to pay Tyler any benefits. Rock-wood and Harvey filed an answer, contending Tyler was able to perform the duties of his employment. On October 7,1993, Tyler filed an amending and supplemental petition substituting Louisiana Insurance Guaranty Association (“LIGA”), Rockwood’s successor, as a party defendant. In their answer to this petition, LIGA and Harvey denied any continuing liability to Tyler and particularly denied any responsibility for the charges of Dr. _|3Luther Stewart. Following LIGA’s refusal to pay benefits, Tyler requested a trial date be set.

Following the trial of this matter, the trial court rendered judgment, awarding Tyler $447.92 per month in SEB, retroactive to August 25, 1994, and continuing for a period not to exceed 270 weeks (520 less 250). The judgment also awarded medical expenses for Dr. Stewart’s services in the amount of $4,892, and costs. In addition, the judgment ordered defendants to provide rehabilitation services pursuant to LSA-R.S. 23:1226, as that statute was in effect on January 18, 1989. Tyler’s request for medical expenses in excess of $4,892, penalties, and attorney’s fees were denied.

Tyler appealed, contending the trial court erred in reducing his weekly or monthly compensation benefits, in limiting the defendants’ responsibility for payment of medical expenses, and in failing to award penalties and attorney’s fees. In their answer to Tyler’s appeal, LIGA and Harvey seek a reversal or reduction of the medical expenses award, a reduction of the SEB award, and an award of all or part of the court costs against Tyler.1 In the event this court finds Tyler permanently totally disabled, defendants request an offset for Tyler’s receipt of social security disability benefits.

Standard of Review

In a workers’ compensation case, as in other cases, the appellate court’s review of factual findings is governed by the manifest error or clearly wrong standard. Smith v. Louisiana Dept. of Corrections, 93-1305, p. 3 (La.2/28/94), 633 So.2d 129, 132; Kennedy v. Security Industrial Ins. Co., 623 So.2d 174, 175 (La.App. 1st Cir.), writs denied, 629 So.2d 389 and 630 So.2d 251 (La.1993). The two-part test for the appellate review of facts is: 1) whether there is a reasonable factual basis in the record for the finding of the trial court, and 2) whether the record establishes that the finding is not manifestly erroneous. Mart v. Hill, 505 So.2d 1120, 1127 (La.1987). If a reasonable factual basis exists, an appellate court may set aside a trial court’s factual finding only if, after reviewing the record in its entirety, it determines the trial court’s finding was clearly wrong. Stobart v. State, Through Dept. of Transportation and Development, 617 So.2d 880, 882 (La.1993). Even though an appellate court may feel its own evaluations and inferences are more reasonable than the fact finder’s, reasonable evaluations of credibility and reasonable inferences of fact should not be disturbed upon review where conflict exists in the testimony. Id. Where there are two permissible views of the evidence, the fact finder’s choice between them cannot be manifestly erroneous or [837]*837clearly wrong. Morris v. Norco Const. Co., 632 So.2d 332, 336 (La.App. 1st Cir.1993), writ denied, 94-0591 (La.4/22/94), 637 So.2d 163.

Discussion

After a thorough review of the record, we are convinced there was a reasonable factual basis to support the following findings by the trial court: Tyler’s condition was not of a temporary nature because he had attained maximum medical improvement; Tyler was not entitled to permanent total disability benefits; Tyler was both physically and intellectually capable of engaging in at least minimum wage employment for an average of twenty-five hours per week; the services of Dr. Luther Stewart were of a nonemergency nature; LIGA denied responsibility for the costs of Dr. Stewart’s services rendered after July 18, 1991; and Dr. Stewart’s office was verbally informed of LIGA’s refusal to consent to further medical treatment on November 7,1991. This court further concludes the record establishes these factual determinations of the trial court were not manifestly erroneous.

Having reached the foregoing conclusions, we now address the issue of LIGA’s liability for the payment of health care services rendered to Tyler by Dr. Stewart. The trial court limited its award to $4,892, based on its conclusion that LIGA was only responsible for medical expenses incurred as a result of treatments up to November 7, 1991.

Tyler contends the trial court erred in limiting LIGA and Harvey’s responsibility for payment of medical expenses associated with Dr. Stewart’s treatments, which he claims were reasonable and necessary. He argues that the mutual consent prerequisite of LSA-R.S. 23:1142(B) is inapplicable because the payor denied the injury was com-pensable. Tyler urges the applicability of LSA-R.S. 23:1142(E), claiming the defendants denied the compensability of his injury when they terminated the payment of weekly or monthly benefits on several occasions. Tyler also submits the filing of their answers to his original ^petition and amending and supplemental petition constituted a denial of compensability. In support of this argument, Tyler cites INA v. Hayes, 93-1648 (La.App. 3rd Cir. 8/31/94), 643 So.2d 190, writ denied, 94-2471 (La.12/9/94) 647 So.2d 1113.

Defendants contend the trial court erred in awarding $4,892 in medical expenses for services rendered by Dr. Stewart prior to November 8,1991. They advanced two theories to support this contention: (1) LSA-R.S. 23:1203(A) only imposes liability for costs associated with necessary medical treatment and (2) LSA-R.S.

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690 So. 2d 834, 96 La.App. 1 Cir. 0326, 1997 La. App. LEXIS 410, 1997 WL 77860, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tyler-v-rockwood-insurance-co-lactapp-1997.