Wal-Mart Associates, Inc. v. Wooden

132 So. 3d 482, 2014 WL 229831
CourtLouisiana Court of Appeal
DecidedJanuary 22, 2014
DocketNos. 47,998-WCW, 48,051-WCW, 48,437-WCA
StatusPublished
Cited by2 cases

This text of 132 So. 3d 482 (Wal-Mart Associates, Inc. v. Wooden) 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
Wal-Mart Associates, Inc. v. Wooden, 132 So. 3d 482, 2014 WL 229831 (La. Ct. App. 2014).

Opinions

WILLIAMS, J.,

for the Court En Banc.

Un these consolidated cases, each workers’ compensation judge concluded that the Medical Treatment Guidelines, set forth in LSA-R.S. 23:1203.1, were substantive laws that could not be applied retroactively. In two of the cases, docket numbers 47,998-WCW and 48,051-WCW, this Court granted supervisory writs to review the correctness of the workers’ compensation judges’ rulings.1 Subsequently, on its own motion, this court consolidated the above cases with an appeal, docket number 48,437-WCA, and elected to consider the three cases en banc,2 Finding no error in the lower courts’ rulings, we affirm the judgment in docket number 48,437-WCA. We recall the writs in docket numbers 47,998-WCW and 48,051-WCW and affirm. We remand these cases to the appropriate workers’ compensation court for further proceedings.

FACTS

Wal-Mart Associates, Inc. v. Wooden

Claimant, Glenda Wooden, was employed by Wal-Mart Associates, Inc. (“Wal-Mart”). On February 20, 2007, Wooden suffered work-related injuries to her nose, back, neck and left shoulder when a box that weighed approximately 25 pounds fell from a shelf and struck her in the face. Medical treatment for Wooden’s injuries included plastic surgery to repair her nose and arthroscopic surgery on her left shoulder. On April 19, 2012, Dr. Bernie McHugh, Wooden’s treating neurosurgeon, recommended that she undergo a diagnostic nerve root block at L4. Wal-Mart forwarded the treatment recommendation to its consultant, Dr. Stephen Pador, for precertification. On April 26, 2012, Dr. Pador recommended that Wal-Mart deny the procedure in accordance with the criteria established in the Medical Treatment Guidelines (“the Guidelines”) as set forth in LSA-R.S. 23:1203.1. Thereafter, based upon Dr. Pador’s recommendation, Wal-Mart refused to authorize the procedure. However, Wal-Mart did not notify claimant’s counsel or her neurosurgeon of Dr. Pador’s recommendation or that Wal-Mart had denied claimant’s request for the medical procedure until May 23, 2012.

On May 30, 2012, Wooden’s counsel filed a disputed claim for medical treatment (LWC-WC Form 1009) with the Medical Services Division of the Office of Workers’ Compensation Administration (“OWCA”). On June 4, 2012, the OWCA acknowledged receipt of the filing, stating, in part, “[Within] [f]ive days after the date of this letter, the LWC-WC [Form] 1009 and any evidence submitted will be filed with the medical director and his 30[-]day review process will begin.” Thereafter, on June 11, 2012, the OWCA erroneously rejected Wooden’s claim, noting that claimant had “fail[ed] to meet the required fifteen[-]day time frame for the submission [of an appeal] to the OWCA as stated in R.S. 23:1203.1(J).”3 The letter from the [485]*485OWCA also stated, “Any party feeling aggrieved by the RS 23:1203.1(J) determination of the medical director shall seek a judicial review by filing Form LWC-WC-1008 Disputed Claim for Compensation with the appropriate hearing office within 15 days of the date said determination is mailed to the parties[.]”

On July 24, 2012, Wooden sought judicial review of the OWCA’s decision by filing a “Motion for Medical Treatment.” Wooden requested that the workers’ compensation judge (‘WCJ”) order Wal-Mart to show cause why it should not be required to authorize and pay for the diagnostic nerve root block. Wal-Mart opposed the motion, arguing that Wooden’s Form 1009 was rejected because it was untimely. Wal-Mart also argued that Wooden should have filed a new Form 1008, instead of filing the motion for medical treatment. In the alternative, Wal-Mart argued that Wooden should have sought judicial review of the OWCA’s rejection of her filing within 15 days.

In response to Wal-Mart’s arguments, Wooden maintained that the Guidelines were not applicable to her case. According to Wooden, her accident occurred in 2007; the Guidelines did not become effective until July 2011. Therefore, the Guidelines could not be applied retroactively to her case.

Sims v. Key Energy Services, Inc.

Marion H. Sims was employed by Key Energy Services, Inc. (“Key Energy”). On March 22, 2011, Sims suffered a work-related injury when he slipped and fell as he attempted to enter a truck. On March 22, 2012, he filed a disputed claim for compensation, seeking past due indemnity benefits, penalties and attorney fees. On September 26, 2012, Sims filed a “Motion to Allow Supplemental 1008,” alleging that Key Energy had denied certain medical treatment recommended by his treating physician, including prescriptions, steroid injections and a spinal stimulator. Sims also alleged that Key Energy was “using the Medical Treatment Guidelines to ‘evaluate’ all requested medical treatment.” He filed a motion in limine, arguing that the Guidelines do not apply retroactively to work-related accidents that occurred prior to July 13, 2011, and, therefore, the Guidelines did not apply to his accident.

Key Energy opposed the claimant’s motion, arguing: (1) in determining whether the Guidelines should be applied, the operative date is the date that the medical services were requested and not the date of the work-related injury; (2) whether the Guidelines should be given retroactive application is a constitutional issue and the workers’ compensation judge (“WCJ”) lacks jurisdiction to hear constitutional issues.

Gagnon v. Jay Mallard Ford

On June 16, 2010, Brian Gagnon suffered a work-related injury during his employment with Jay Mallard Ford. On April 14, 2011, he underwent a laminectomy at L4-L5, and subsequently endured several weeks of physical therapy as ordered by his treating physician. However, he |ficontinued to experience intense low-back pain. Thereafter, in August 2011, Dr. Eu-bulus Kerr, Gagnon’s treating physician, determined that a second surgery (a post[486]*486er lumbar interbody fusion and laminecto-my at L3-L4/L4-L5) was necessary.

Dr. Kerr submitted the request for a second surgery to Jay Mallard Ford’s chosen utilization-review provider. Without making a decision on the recommendation, the provider requested additional information. When the additional information was not provided, the request for approval of the surgery was deemed withdrawn.

On January 31, 2012, Gagnon filed a disputed claim for medical treatment (LWC-WC Form 1009) with the Medical Services Division of the OWCA. The claim was denied on the basis that the requested medical procedure did not comply with the Guidelines.

On March 28, 2012, Gagnon sought judicial review of the OWCA’s decision. He argued that the Guidelines did not apply to his case because his work-related accident occurred prior to their effective date.

These cases were tried by two different Districts. The Wooden and Gagnon matters were tried by WCJ Brenza Irving Jones in District IE; the Sims matter was tried by WCJ Patrick Robinson in District 1W.

In Wooden, the WCJ found that the Guidelines could not be applied retroactively, and, thus, were not applicable to Wooden’s case.4 The judge | (¡ordered Wal-Mart to authorize and pay for Wooden’s diagnostic nerve root block by December 12, 2012. In Sims,

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132 So. 3d 482, 2014 WL 229831, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wal-mart-associates-inc-v-wooden-lactapp-2014.