Insurance Dispute Lawyer Blog
Navigating bureaucracy and red tape is a common experience when dealing with government agencies and trying to obtain workers’ compensation benefits. However, if you find yourself frustrated by what seems like an improper requirement, you might be able to challenge an administrative agency’s actions as exceeding its authority, as Calvin Arrant did here.
While working at Wayne Acree PLS, Arrant was involved in an accident where a truck that ran a red light hit his vehicle. Arrant consulted an attorney and then met with an orthopedic surgeon because he started having back pain that went down his legs. The doctor recommended an MRI.
His attorney contacted Acree’s workers’ compensation carrier to determine if it would agree to cover the MRI. Twice, Arrant requested approval for the MRI from the medical director under La. R.S. 23:1203.1. Both times, the medical director denied Arrant’s request via fax.
Arrant filed a Disputed Claim for Compensation with the Office of Workers’ Compensation (“OWC”) to review the medical director’s denial of his request for the MRI. Wayne Acree and its workers’ compensation carrier filed an exception of prescription, claiming Arrant failed to appeal the decision within 15 calendar days of receiving the denial from the medical director. The OWC ruled in favor of Wayne Acree, finding that Arrant had not timely filed his appeal within the required 15 calendar days (called the prescription period). The Louisiana Second Circuit Court of Appeal affirmed the decision in favor of the defendants. Still seeking to remedy the problem, Arrant appealed to the Louisiana Supreme Court.
The Louisiana Supreme Court considered whether the medical director exceeded the authority the Louisiana Legislature delegated to it by creating a 15 calendar day period for an injured worker to appeal the denial of a request for medical treatment. The Court first considered whether the statute that created the OWC (La. R.S. 23:1291) provided the medical director with authority to implement a 15 calendar day period for an injured worker to appeal a medical director’s finding. The statute did not explicitly provide this authority.
The Court explained the Louisiana Legislature has the authority to establish time limits for someone to bring a legal claim. See La. C.C. art. 3457. Under La. R.S. 23:1203.1, the OWC has statutory authority to create rules to provide the standard medical treatment for injured workers and a process for an injured worker to request different treatment and appeal a denial of that request. However, the Legislature already created a prescriptive period for bringing claims like Arrant’s related to medical benefits in La. Rev. Stat 23:1209, the OWC did not have the authority to create and enforce a shorter prescriptive period.
Therefore, the Louisiana Supreme Court found that the hearing officer erred in sustaining the defendants’ peremptory exception of prescription and remanded for the Office of Workers’ Compensation to evaluate Arrant’s claim that the medical director did not appropriately apply medical treatment guidelines when he denied Arrant’s request for an MRI of his spine.
As demonstrated by Arrant’s case, it is possible to challenge administrative agencies that exceed their authority. The Louisiana Supreme Court’s ruling sheds light on the importance of understanding the boundaries of agencies such as the Office of Workers’ Compensation (OWC) and seeking legal counsel to navigate the workers’ compensation scheme effectively. If you are entangled in a similar situation, consulting with an experienced attorney becomes crucial to explore potential remedies and protect your rights.
Additional Sources: Calvin Arrant v. Wayne Acree PLS, Inc. & Louisiana Workers’ Comp. Corp.
Additional Berniard Law Firm Article on Prescription Periods: Trial Court Decision Overturned Due to Prescription Period Expiring