Late payments, denial of treatment entitle worker to attorney's fees
Case name: Ford v. House of Raeford, No. 46,454-WCA (La. Ct. App. 08/10/11).
Ruling: The Louisiana Court of Appeal held that a worker was entitled to $3,000 in penalties and $2,000 in attorney's fees for her employer's late payments of benefits and denial of medical treatment.
What it means: In Louisiana, an employer can avoid penalties for late payments or a lapse in paying benefits if it can show the claim for payment of indemnity benefits was reasonably controverted or that the nonpayment resulted from conditions over which it had no control.
Summary: A worker at a chicken plant was injured when she fell down stairs at work. She continued working for two months until her physician restricted her from working because of the injury. She sought workers' compensation benefits, and she received temporary total disability benefits. She sought penalties and attorney's fees, alleging that the plant was late in paying the initial payment of indemnity benefits, untimely paid or never paid subsequent indemnity benefits, failed to provide copies of medical reports from its doctors, and failed to authorize additional medical treatments. The Louisiana Court of Appeal held that the worker was entitled to $3,000 in penalties and $2,000 in attorney's fees.
The court noted lapses in the payment of weekly benefits. The plant blamed the delays on a change in third-party administrators. The court said the plant did not show the claim for payment of indemnity benefits was reasonably controverted or that the nonpayment resulted from conditions over which it had no control. The court assessed a penalty of $2,000.
The worker's physician suggested an MRI when the worker had pain he thought was caused by scar tissue. The adjuster denied the request. The MRI was approved three months later. The physician also recommended a discogram to diagnose the cause of the worker's pain. The adjuster denied the claim. The physician later agreed with a second medical opinion that the worker was not a candidate for the discogram. The court awarded a $1,000 penalty for the refusal to approve the MRI. The court found no penalties were appropriate for the failure to authorize the discogram because it was not necessary for the worker's treatment.
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September 30, 2011
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