Articles Posted in Workers Compensation

green_mold_harmful_moldIf you have experienced symptoms from working in a moldy work environment, you might think you are entitled to recover from your employer. However, navigating the Workers’ Compensation system can be challenging partly because of the distinct and often complicated vocabulary in the statutes. This case involves defining an occupational disease under the Louisiana Workers’ Compensation Act.

Angela Lyle worked in the payroll department at Brock Services. Her office was in a trailer in Norco, Louisiana, at the Valero plant. Lyle claimed she saw mold throughout the trailer that increased over the two years she worked at the site. She suffered from fatigue, burning eyes, sores, and other symptoms. After suffering a nosebleed, she underwent a medical evaluation. Testing confirmed mold was present in the office, so Lyle’s trailer was replaced. Once the trailer was replaced, some of Lyle’s symptoms went away, but others persisted, and new symptoms emerged. 

She resigned and was diagnosed with sarcoidosis in her lungs and lymph nodes. She then filed a claim with the Workers’ Compensation, claiming she had suffered an occupational disease and was entitled to damages. The workers’ compensation judge denied her claim as neither her mold exposure nor the development of sarcoidosis qualified as an occupational disease or accident under the Louisiana Workers’ Compensation Act. Brock filed a summary judgment motion, arguing Lyle could not establish sarcoidosis was an occupational disease. The workers’ compensation judge granted Brock’s summary judgment motion, finding Lyle’s sarcoidosis was not an “occupational disease. Lyle appealed, arguing the workers’ compensation judge ignored the definition of an “occupational disease” under the Louisiana Workers’ Compensation Act.

ladder_step_ladder_passage-scaledStatutory employer immunity is critical in determining liability and compensation for workplace injuries in workers’ compensation. The following case is an example where the court had to decide whether the defendant was entitled to statutory employer immunity under the dual contract theory provided for in La.R.S. 23:1061(A)(2). We will examine the facts of the case, the arguments presented by both parties and the court’s decision. We will also examine the legal framework surrounding statutory employer immunity and its impact on workers’ compensation cases.

The case involves Patrick Cummins, a worker hired by a subcontractor to perform its contract with R.A.H. Homes and Construction, LLC (“R.A.H.”), the defendant. The homeowners had contracted R.A.H. to construct a single-family home, including the installation of an attic HVAC system. Cummins became seriously injured when the attic access ladder malfunctioned, and he fell while performing the work required under R.A.H.’s contract with the homeowners.

Cummins sued several defendants, including R.A.H., in tort, alleging that R.A.H. was directly responsible for the improper installation of the attic ladder that led to the accident. In response, R.A.H. asserted an affirmative defense of statutory employer immunity under La.R.S. 23:1061(A)(2), claiming that a statutory relationship existed through the two-contract theory.

building_company_glass_building-scaledWhen an individual sustains an injury while on the job, the anticipation of receiving workers’ compensation to tide them over during their recovery is natural. Regrettably, situations arise where companies are unwilling to shoulder this responsibility. The scenario becomes more intricate when a parent company distances itself from its subsidiary’s actions, attempting to evade liability for workplace injuries. This particular Louisiana Court of Appeals case delves into corporate responsibility, illuminating the circumstances under which a parent company is held accountable for the safety measures enacted by its subsidiary entities.

Plaintiff, Truman Stanley, III, had his arm tragically severed at work when a defective oxygen cylinder exploded, and steel fragments broke off. He filed a personal injury lawsuit against Airgas USA seeking tort recovery. He later amended his complaint to include Airgas Inc., the parent company of Airgas USA, claiming it developed safety procedures and protocols and instructional materials/safety training that was inadequate and flawed, creating an unsafe workplace. Therefore, Stanley believed Airgas, Inc. should be liable in tort. The parent company moved for summary judgment stating it was immune from tort liability under the Louisiana Workers’ Compensation exclusive-remedy provision. The trial court ruled in favor of the defendant and granted summary judgment. Stanley appealed, claiming the trial court erred in finding the parent company immune from tort liability.

Louisiana Revised Statutes 23:1032 contains the exclusive-remedy provision under the Louisiana Workers’ Compensation Act, which states the employer and anyone who may act as the employer are immune parties. However, for the immunity to apply, it “must have been engaged at the time of the injury in the normal course and scope of the employer’s business.” Under Louisiana Revised Statutes 23:13, an employer’s legal duties that cannot be delegated include providing safe working conditions for employees. That being said, providing a safe work environment falls within the course and scope of every employer’s business. If the parent company took on Airgas USA’s role, Airgas Inc. would be immune from tort liability.

supreme_court_building_washington_3_5-scaledLouisiana’s Workers’ Compensation fund exists to pay employees injured at work.  Payment can be used for medical care and lost wages.  When parties sign a settlement agreement on payment terms, an employee may assume payment is imminent.  In a recent case from Rapides Parish, an employee discovered some conditions in a settlement may delay payment.  

Mary Ortega sustained an injury while employed by Cantu Services.  Ortega filed a Disputed Claim for Compensation, and the parties entered a settlement agreement.  The parties settled for $120,000.  $56,049 of the total was allocated to a Medicare set-aside agreement (MSA) to cover future medical expenses related to the work injury. The MSA was filed with the Centers for Medicare and Medicaid Services (CMS) for approval.  The parties agreed that if CMS did not approve the full amount in the MSA, the employer would adjust the amount paid in monetary benefits, so Ortega would still receive $120,000.  Several months after signing the agreement, Ortega had not received any payments.   She filed a motion to enforce the settlement agreement plus a request for fees and penalties before the Office of Workers’ Compensation.   

The Workers’ Compensation Judge (WCJ) denied Ortega’s request because payment under the settlement agreement was conditioned on first getting approval from the MSA.   Pending approval suspended the statutory requirement of payment within thirty days.    Ortega appealed to the Louisiana Third Circuit Court of Appeal.     

inflatable_obstacle_course_1455632-scaledInjury in the workplace can usually be avoided with proper safety measures in place. Safety measures, however, become hard to enforce when minors and adults work in conjunction. This was the case for Austin Griggs, an illegally employed minor injured in a forklift accident while working.

Bounce N’ Around Inflatables, LLC (BNA) supplies rentable party inflatables for personal or corporate events. When not in use, the inflatables are stored on racks that are 10 feet high. To move the inflatables, a battery-operated pallet jack was required. Griggs began working for BNA at the age of 14. BNA employed about 12 minors at the time Griggs was injured. Griggs testified that he had never been told that a work permit was required to work at BNA.

On the day of injury, Griggs was helping another employee pick up and sort the inflatables. This required Griggs to get the inflatable onto the forklift, and then the other employee would use the forklift to move the inflatable into the rack. During this process, Griggs was required to use his weight to counterbalance the inflatable as the forklift lifted the inflatable upwards. Griggs testified that this was standard practice at BNA. During the lift, Griggs fell off the forklift. Then, the inflatable followed, landing on Griggs’s lower back. 

sugar_cane_fields_okinawa-scaledUnfortunately, accidents in the workplace are not uncommon. What happens, however, if you unknowingly signed an agreement making your employer immune from a liability claim? The following Lafourche Parish case outlines this predicament. 

In September 2013, Neville Patterson signed multiple documents with Raceland Raw Sugar, LLC (RRS) and Raceland Equipment Company, LLC (REC) to haul sugar cane for the former. Included in this paperwork was an indemnification agreement identifying Patterson as the contractor and RES and RRS as statutory employers. 

Two months later, Patterson created N-A-N Trucking, LLC (N-A-N) and started to operate his truck. Following this development, RRS began making checks from hauls payable to N-A-N. These checks were endorsed by Patterson, who continued to receive driver wages from REC. 

workers_road_workers_site-scaledSettling a lawsuit can have many far-reaching effects. Not only will it result in the dismissal of your lawsuit, but it could also affect things such as your social security benefits. Therefore, it is important that you consult with an attorney and carefully consider if a settlement is in your best interest. Additionally, as seen in this case, if you accept a settlement offer, you must ensure the related court order includes all required aspects so you do not have to deal with unintended consequences. 

Kenneth Clark and his employer, Walgreens, reached a settlement related to Clark’s workers’ compensation claim. A workers’ compensation judge approved the settlement and entered a judgment dismissing the claim. Clark then petitioned the workers’ compensation judge to amend the judgment to include language to divide the indemnity part of his settlement across his lifetime. This proposed amendment would not change the total amount of the settlement. Clark wanted this amendment so the Social Security Administration could pro-rate the settlement so it could calculate the required disability offset. Walgreens objected to this amendment. After a hearing, a workers’ compensation judge entered an amended order reflecting Clark’s requested language. Walgreens appealed. 

On appeal, Walgreen argued the trial court did not have jurisdiction to amend the initial order approving Clark’s settlement with Walgreens. La. R.S. 23:1272 governs the settlement of workers’ compensation claims. This statute has many safeguards for preventing an employee from being pressured to improperly settle his or her claim. Courts are to liberally construe workers’ compensation law in favor of workers to protect them from the burden of workplace injuries. 

manzanar_relocation_center_manzanar_445-scaledBeing injured at work is never what you want to deal with. What’s worse is dealing with multiple independent medical examiners making opinions on your medical state. In the following case, the Louisiana Court of Appeal First Circuit addresses whether a medical examiner’s determination of maximum medical improvement is closely related to the worker’s condition and ability to work.

Ella Hamilton injured her neck and shoulders while moving trash bags into a dumpster while working as a custodian for GCA Services. Hamilton filed a workers’ compensation claim, and GCA Services paid indemnity and medical benefits to and on behalf of Hamilton in connection with her workers’ compensation claim. A dispute arose between the doctors that reviewed Hamilton’s alleged injuries and whether or not he could return to work.

Dr. Charles Bowie, a neurosurgeon, diagnosed Hamilton with a cervical disc disorder and opined that she required cervical fusion surgery. He believed her injuries prevented her from working. On the other hand, Dr. David Ferachi, an orthopedic surgeon representing GCA Services, agreed with Dr. Bowie but stated that Hamilton could return to work as a custodian with certain limitations.

money_pay_money_making-scaledSuppose you are considering settling a lawsuit related to injuries on the job. In that case, it is essential to understand how a potential settlement of a related claim could affect your workers’ compensation benefits. What happens to your workers’ compensation benefits if you settle a related lawsuit without written approval from your employer and their workers’ compensation insurer? The following case helps answer that question.

While working at Mouton Plumbing, Terrell Talbot was involved in a car accident. Mouton Plumbing and its workers’ compensation insurer accepted Talbot’s claim under La. R.S. 23:1021. He received $69,265.02, consisting of workers’ compensation indemnity benefits of $23,487.86 and medical expenses of $45,777.16. Talbot filed a lawsuit against the other individual involved in the car accident and her insurer. Pursuant to La. R.S. 23:1102(A), Talbot notified Mouton Plumbing and its insurer in writing about the lawsuit. They intervened in Talbot’s case. Talbot settled the lawsuit for $107,389,73 but did not obtain written approval from Mouton Plumbing or its insurer. As a result, the insurer ended Talbot’s workers’ compensation benefits. 

Under La. R.S. 23:1102(B), a worker is not entitled to workers’ compensation benefits if he does not obtain the employee or insurer’s approval to settle a related lawsuit. However, an employee can reclaim his workers’ compensation benefits through a “buy-back provision.” When Talbot’s benefits were terminated, a lien from Mouton Plumbing’s insurer was not satisfied. As a result, the $28,730.84 due to Talbot from the settlement, after deducing attorney’s fees and costs, was paid directly to the insurer to satisfy the lien. 

insurance_damage_repair_checklist-scaledThe process of filing insurance claims can be time-consuming, demanding careful attention from all parties involved. In a recent ruling by the First Circuit Court of Appeal in Louisiana, the importance of timely and exhaustive pursuit of administrative remedies before seeking judicial review in insurance payment disputes was underscored. The case of Southern Framers of Louisiana, LLC (Southern Framers) sheds light on the consequences of premature legal action, emphasizing the need to explore alternative avenues, such as administrative proceedings, before resorting to the courts. Through an examination of Southern Framers’ dispute with a healthcare provider, this ruling serves as a valuable reminder for future litigants to exhaust administrative remedies diligently and consider the proper timing and procedures in pursuing legal recourse.

After Rafael Diaz (Mr. Diaz) injured his shoulder during the scope of his employment with Southern Framers, he underwent rotator cuff surgery which Dr. Richard Texada performed at Doctor’s Hospital of Slidell d/b/a Sterling Surgical Hospital (Hospital). Following Mr. Diaz’s surgery, the Hospital sent a bill for $33,133.41 to Southern Framers’ insurance carrier Louisiana Homebuilders Association-Self Insured Fund (Carrier). On behalf of Southern Framers, the Carrier paid $8,887.80 to the Hospital, indicating what they believed was a “reasonable reimbursement for services” in Mr. Diaz’s surgery. As a result, the Hospital filed an administrative review according to their rights within Louisiana Administrative Code Title 40, pt. I, § 5149 (Title 40), for this underpayment of the Hospital’s services.

Neither Southern Framers nor the Carrier responded to the administrative review. Instead, they filed a “Disputed Claim for Compensation” with the Office of Workers’ Compensation (OWC), stating that the unpaid portion of the original $33,133.41 bill was unreasonable. Southern Framers took this claim further, alleging that even the $8,887.80 previously paid to the Hospital by the Carrier was an overpayment and demanded reimbursement. The Hospital responded to the OWC complaint, raising multiple objections, including prematurity, and disputing the claims for reimbursement. At the hearing, the OWC judge sustained the Hospital’s prematurity objection, finding that Southern Framers and the Carrier failed to follow the administrative remedies of Title 40. The OWC judge called this claim “an attempt to circumvent the procedure that’s supposed to streamline and make the payments go quicker and faster without going through the hearing process.”

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