Vidrine v. Argonaut-Southwest Insurance

166 So. 2d 287, 1964 La. App. LEXIS 1150
CourtLouisiana Court of Appeal
DecidedJuly 10, 1964
DocketNo. 1168
StatusPublished
Cited by7 cases

This text of 166 So. 2d 287 (Vidrine v. Argonaut-Southwest 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
Vidrine v. Argonaut-Southwest Insurance, 166 So. 2d 287, 1964 La. App. LEXIS 1150 (La. Ct. App. 1964).

Opinions

HOOD, Judge.

This is a workmen’s compensation suit in which plaintiff alleges that he is totally and permanently disabled as the result of a back injury which he sustained during the course of his employment by Joe’s Tin Shop in Ville Platte, Louisiana. Although originally instituted against two defendants, the suit was subsequently dismissed as to one of them, and the sole defendant now is Argonaut-Southwest Insurance Company, the compensation insurer of the employer.

The defendant failed to answer within the 10-day period allowed by LSA-R.S. 23:1315, and a preliminary judgment was rendered in favor of plaintiff. Immediately after that judgment was rendered, the defendant filed a number of pleadings, including an answer and an exception of prematurity. After trial on the exception, judgment was rendered by the trial court maintaining the exception of prematurity, dismissing plaintiff’s suit and recalling, rescinding and vacating the preliminary judgment theretofore rendered in this case. Plaintiff has appealed.

The record shows that plaintiff sustained a back injury as the result of a work-connected accident which occurred on August 21, 1963. The defendant received no notice of this accident and had no knowledge of it until October 29, 1963, on which date plaintiff’s employer filled out and mailed to defendant a report of the accident. On the following day, October 30, plaintiff’s counsel wrote to defendant formally demanding that compensation payments be made. Defendant replied by letter dated November 8, advising counsel that that was the first notice defendant had had of the alleged accident, that the company was having its claim representative, Mr. Irvan Andignac, “check this out and he will be in touch with you shortly.” On November 13, Mr. An-dignac wrote to plaintiff’s counsel advising that he was investigating the claim, that he had made an appointment for plaintiff to be examined by an orthopedist in Lafayette on December 2, 1963, and that he “will be in touch with you further.” Mr. Andignac wrote to plaintiff’s counsel again on November 20, 1963, advising that the investigation would be completed within less than 60 days after the company had been notified of the accident, and that if the company feels after this investigation that the claim is compensable “we will start our payments bringing your claim up to date.” Counsel for plaintiff received this letter on either November 21 or 22, but the suit nevertheless was instituted on November 21, 1963, which was 23 days after defendant first learned of the accident and injury.

After the suit had been filed, defendant’s claim representative determined that plaintiff had been discharged by his treating physician on October 24, 1963, as being fully recovered and able to return to work. At the same time he also learned that on October 29, or five days after plaintiff had been discharged from treatment, he was involved in an automobile accident and that he claimed to have sustained additional injuries in that accident. After receiving this information, the claim representative wrote to plaintiff’s counsel on November 26, advising that the company “must at this time respectfully decline liability for your client’s present injury." This letter, as we have already pointed out, was written after the suit had been filed. Plaintiff contends that in this letter the claim representative specifically denied liability for compensation for the injury which plaintiff sustained on August 21, 1963, while defendant maintains that the claim representative was merely denying liability for the injuries allegedly sustained by plaintiff as a result of the automobile accident which occurred on October 29, for which injuries defendant had provided no insurance coverage.

[290]*290Defendant contends that plaintiff’s action is premature and should he dismissed pursuant to the provisions of LSA-R.S. 23:1314, because defendant has not “refused to pay” the maximum percent of wages to which plaintiff is entitled. It contends that the employer, or his insurer, is entitled to a reasonable period of time after receiving notice of the alleged injury within which to make an investigation and to commence the payment of compensation benefits, and that a suit instituted before a reasonable period of time for that purpose has elapsed is premature. In this instance defendant argues that the suit was instituted before it had been allowed a reasonable time within which to investigate. Plaintiff, on the other hand, contends that defendant’s failure to pay compensation benefits within the 23-day period which elapsed between the time defendant received notice of the accident and the time the suit was filed was sufficient to justify an inference that it had “refused to pay” the compensation due.

LSA-R.S. 23:1314 provides that a workmen’s compensation suit shall be premature and shall be dismissed if the plaintiff fails to allege, among other things, that the employer has “refused to pay” the maximum percent of wages to which the petitioner is entitled. Even though allegations to that effect are made by the plaintiff, the suit may still be held to be premature and dismissed if those allegations are denied by the defendant and it is shown at a hearing that such allegations “are without reasonable cause or foundation in fact.”

It is settled that where there has been an implied refusal to pay compensation benefits, then it is not necessary that there be an express refusal to do so in order to constitute a “refusal to pay” within the meaning of LSA-R.S. 23:1314. Boss v. Marquette Casualty Company, La.App. 3 Cir., 150 So.2d 67 (Cert. denied).

It also is settled that in determining whether a compensation suit is premature the employer, or his compensation insurer, is allowed a reasonable time after receiving notice or actual knowledge of the accident and injury within which to investigate the matter and to begin compensation payments. Bertrand v. Patterson Truck Line, La.App. 3 Cir., 138 So.2d 663 (Cert. denied); Dawson v. Barber Bros. Contracting Co., La.App. 1 Cir., 195 So. 46; Pea v. Hardware Mutual Casualty Company, La.App. 2 Cir., 147 So.2d 472; Fontenot v. Cox, La.App. 1 Cir., 68 So.2d 656 (Cert. denied); Glover v. Schuylkill Products Company, La.App. 1 Cir., 138 So.2d 15 (Cert. denied); Marshall v. Aetna Insurance Company, La.App. 2 Cir., 154 So.2d 263. See also Malone, Louisiana Workmen’s Compensation, Section 383, page 490. The question of what is a “reasonable time” within which to complete such an investigation and to commence the payment of compensation benefits must be determined from the peculiar facts of each case. Pea v. Hardware Mutual Casualty Company, supra.

In this case there was no express refusal to pay before the suit was filed, and in our opinion the evidence does not justify a conclusion that there was an implied refusal. At the time defendant first learned of the accident and injury, just 23 days before the suit was filed, it had received no medical reports from plaintiff and it had received no demand for compensation benefits. It nevertheless proceeded promptly to investigate the claim, it arranged to have plaintiff examined by an orthopedist, and it advised plaintiff’s attorney several times during the short interval of time which intervened between the first notice of the accident and the filing of the suit that the matter was being investigated and that the investigation would be completed within a relatively short period of time. In spite of this, the suit was filed while the investigation was being made, before defendant was furnished with any medical reports, and before it had had an opportunity to have plaintiff examined by a physician.

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Bluebook (online)
166 So. 2d 287, 1964 La. App. LEXIS 1150, Counsel Stack Legal Research, https://law.counselstack.com/opinion/vidrine-v-argonaut-southwest-insurance-lactapp-1964.