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Lake Charles, LA - Workers' Compensation lawyer represented defendant with appealing the judgment in favor of temporary total disability benefits.
Mr. Evans was employed by IP at its facility in Campti, Louisiana, on Friday,
June 17, 2016, when he claims he began to experience pain in his left leg. He was
initially seen at the emergency room at Christus Coushatta Health Care Center,
where he was diagnosed with shin splints. Later, Mr. Evans sought treatment with
the doctors of Orthopedic Specialists of Louisiana in Bossier City, who diagnosed
him with a stress fracture or stress reaction in his left tibia. Subsequently, Mr. Evans’
tibia fractured at his home, and he required surgery to fix the fracture, which
involved the installation of an intermedullary nail and screws. Mr. Evans claims to
continue to experience problems with his left leg that he asserts prevent him from
working. His primary orthopedic surgeon, Dr. Val Irion of Orthopedic Specialists,
has recommended a surgery to remove the intermedullary nail and screws now that
the fracture is healed.
There is no dispute that, prior to filing his Disputed Claim for Compensation
Form 1008, which initiated his claim for workers’ compensation benefits, Mr. Evans
had not filed a formal accident or incident report as required by IP’s internal policies
and procedures. Mr. Evans did not file his claim for compensation until June 12,
2017, almost a year after his injury. Before filing his claim, Mr. Evans had taken
time from work pursuant to Family and Medical Leave Act (FMLA) protections and
had received benefits from a short-term disability policy he had procured through IP.
His medical bills had been paid by his group health insurance, also procured through
IP denied Mr. Evans’ claim for compensation, arguing that it was not notified
of any compensable injury until shortly before the expiration of Mr. Evans’ health
insurance benefits. The matter proceeded to trial before the WCJ. Only Mr. Evans
and Claire Wimbiscus, IP’s Human Resources Manager, gave live testimony. The
depositions of several other witnesses, including Dr. Irion, were introduced. The
following represents the testimonies given at trial or in deposition.
Mr. Evans testified that, on June 17, 2016, he was following Ronnie Comick,
a maintenance oiler who was training Mr. Evans on preventive maintenance tasks in
the paper machine number 2 area of the plant. When Mr. Evans complained of leg
pain, Mr. Comick suggested that Mr. Evans wait for him to climb the several flights
of stairs the duo were to ascend in order to access the “save-all” area where they
were to conduct some preventive maintenance. Mr. Evans, though, insisted on
making the ascent but had to be assisted by Mr. Comick to descend the stairs. Mr.
Comick recalled Mr. Evans telling him his leg was hurting before they ascended the
“save-all,” while Mr. Evans recalls telling Mr. Comick after they ascended to the
“save-all.” They had begun their workday in what is referred to as the basement, but
is actually ground level. Both Mr. Comick and Mr. Evans testified that Mr. Evans’
first complaints were voiced at least an hour into the workday.
At or around the lunch break, Mr. Evans told his department’s Safety Captain,
Roderick Williams, that his leg was bothering him. Mr. Williams advised Mr. Evans
to go sit in the “clamp truck shop,” but then reconsidered because Mr. Evans was
not assigned to the clamp truck shop. Instead, Mr. Williams had Mr. Evans sit in an
area on the main floor of the plant. Mr. Williams and Mr. Comick were able to
complete their assigned duties as well as Mr. Evans’ duties. At no time on Friday
did Mr. Evans file an accident report. Mr. Evans testified that he reported his injury
to Craig Wade, his supervisor on Friday.
Over the weekend, Mr. Evans rested and elevated his leg but continued to
experience problems. On Monday, June 20, Mr. Evans called Mr. Wade and told
him he was having problems with his leg. Mr. Wade testified that this was the first
indication that Mr. Evans had injured his leg. He assumed that Mr. Evans had hurt
his leg over the weekend because the events of Friday, June 17, had not been reported
to him and in the conversation of Monday, June 20, Mr. Evans did not tell Mr. Wade
that his leg pain had begun while on the job.
Mr. Wade advised Mr. Evans to seek medical attention and testified that he
thought that he also advised Mr. Evans to file an FMLA request on that same date.
Mr. Evans went to the emergency room at Christus Coushatta Health Care Center.
The personnel there diagnosed him with shin splints and advised him to elevate and
ice his leg.
On Tuesday, June 21, Mr. Evans returned to the IP plant, but was still
experiencing leg pain. He went to the nurse’s station at the plant but found no one
there. He attended the morning “breakout” meeting but decided that his pain was
too great to allow him to work. He testified that he informed Mr. Wade and Mr.
Williams of this, then prevailed upon Otis Farley, a millwright mechanic assigned
to the clamp truck shop, to drive him to the gate. Mr. Farley recalled in his testimony
that this was on Monday, June 20.
Mr. Comick, Mr. Williams, and Mr. Farley all testified that they have not be
asked by anyone at IP about Mr. Evans’ injuries or other matters related to the claim.
Mr. Evans then sought treatment with Orthopedic Specialists. He was seen
on June 21 by Dr. Clinton McAlister, who diagnosed him with a stress fracture
versus periostitis and prescribed a Medrol dosepak and an MRI. On June 27, Mr.
Evans was seen by Dr. Michael Acurio, a partner of Dr. McAlister, who also felt Mr.
Evans had a stress fracture. The MRI, taken on June 30, confirmed a stress fracture
or stress reaction in Mr. Evans’ left tibia. Mr. Evans was put on crutches and was to
return to Dr. Acurio had the leg not completely fractured on July 4, 2016, at Mr.
Evans’ home. Mr. Evans went to the emergency room at Willis-Knighton Hospital
in Shreveport, where he was seen by Dr. Irion, who performed the surgery on July 5
to fix the fracture. Dr. Irion has assumed Mr. Evans’ care since the surgery.
The records of Christus Coushatta and or Orthopedic Specialists are, however,
devoid of any reference to the left leg injury being work-related.
According to Dr. Irion, the most common cause of a stress reaction is a recent
increase in workload or exercise activity. Stress reactions are also common among
individuals with misaligned bones and obesity, and Mr. Evans presented with both
of those conditions. He also had experienced a recent increase in the amount of
walking and stair-climbing he was required to do at work. These three factors led
Dr. Irion to relate the stress reaction to Mr. Evans’ work. The fracture of the left
tibia was secondary to the stress reaction. He has recommended an additional
surgery to remove the intermedullary nail and screws to alleviate the pain Mr. Evans
continues to experience in his left leg.
The WCJ issued oral reasons that were read into the record in this matter. Mr.
Evans, the WCJ found, was a “highly credible” witness. The testimonies of the
various witnesses, the WCJ also found, corroborated Mr. Evans’ claim that he
sustained an injury on June 17, 2016, while at work at IP. The WCJ then cited
several cases that he found supported his determination that Mr. Evans’ injury was
compensable. The WCJ then ruled as outlined above. Following the signing of
judgment, this appeal was lodged by IP.
ASSIGNMENTS OF ERROR
IP asserts the following as errors on appeal:
1. The Trial Court committed error when he found that Claimant, James Evans,
proved that his injury was the result of the occurrence of an “accident” as
defined by La. R.S. 23: 1021(1), which occurred in and/or arose out of the
course and scope of his employment with International Paper Company.
2. The Trial Court committed error when it awarded Claimant $53,590.42 in
medical expenses already paid by a third-party insurer, CIGNA, who was a
solidary obligor with IP, with regard to the relevant medical expenses, and
pursuant to La. R.S. 23:1212 and La. R.S. 1205, payment by CIGNA
extinguished the obligation of IP to reimburse Claimant for these expenses.
3. The Trial Court committed error in by [sic] calculating Claimant's average
weekly wage to include a “regular” and “overtime” average weekly wage to
determine that his total average weekly wage is $1,097.69.
Mr. Evans asserts that the WCJ manifestly erred in not awarding him penalties
and attorney fees.
IP’s first assignment of error:
An employee is required to prove that he sustained injury in an “accident
arising out of and in the course of his employment” to receive workers’
compensation benefits. La.R.S. 23:1031(A). Whether an accident has occurred is
viewed from the employee’s perspective. Bruno v. Harbert Intern. Inc., 593 So.2d
357 (La.1992). The requirement has always been interpreted by our courts liberally.
Id. Furthermore, an accident can occur “when ‘heavy lifting or other strenuous
efforts, although usual and customary, cause or contribute to a physical breakdown
or accelerate its occurrence because of a pre-existing condition.’” Id. at 360 (quoting
Cutno v. Neeb Kearney & Co., 237 La. 828, 112 So.2d 628, 631 (1959)). A worker’s
testimony can discharge his burden of proof as long as it is supported by
corroborating circumstances and no other evidence casts serious doubt on his
testimony. Id. Corroboration can take the form of testimony from fellow employees
or medical evidence. Id.
The determination that an employee has carried his burden of proof is a factual
finding subject to reversal only if it is clearly wrong or manifestly erroneous, even
when that finding is based solely upon records or depositions. Id. Under the
manifest error standard, the appellate court must look at the record in its entirety and
give great deference to the trier of fact’s determination. Rosell v. ESCO, 549 So.2d
840 (La.1989). “Where there are two permissible views of the evidence, the
factfinder’s choice between them cannot be manifestly erroneous or clearly wrong.”
Id. at 844.
In the present case, Mr. Evans testified that he began to experience left leg
pain as he was ascending the save-all stairs. Mr. Comick recalled him complaining
of his leg before they began the ascent. Both recall the complaints beginning after
the pair had been working for some time. Mr. Williams recalls Mr. Evans
complaining of leg pain on June 17, 2016.
Mr. Evans did not complete an accident or incident report as required by IP’s
policies and procedures. There was a dispute in the testimony over whether he
informed Mr. Wade, who was technically his supervisor, of the injury on June 17,
2016. Mr. Evans did tell Mr. Wade on Monday, and Mr. Wade assumed that the
injury had occurred over the weekend. Mr. Comick knew of the injury, as did Mr.
Williams, the Safety Captain; when asked about whether Mr. Comick was his
supervisor, Mr. Evans replied that Mr. Comick was training him, which reflects an
ambiguity over their relationship that might lead one to conclude that Mr. Comick
was a supervisor in a real sense, if not in the eyes of IP.
When his incident occurred, Mr. Evans did not follow company procedures in
reporting his injury. Instead, he continued to work as much as he could. After the
weekend of rest and elevation did not alleviate Mr. Evans’ pain, he contacted Mr.
Wade on Monday, June 20. Mr. Wade quite reasonably assumed that Mr. Evans had
injured his knee over the weekend, as he was not informed otherwise by Mr. Evans.
Mr. Evans sought treatment shortly after the incident. His treatment continued
through the fracture of his left tibia and subsequent surgery. His treating orthopedic
surgeon related the left tibia stress reaction to Mr. Evans’ job responsibilities and the
fracture to the stress reaction.
Given these circumstances, we find that the WCJ did not err in finding that
Mr. Evans carried his burden of proving an “accident.”
IP’s second assignment of error:
IP complains that the WCJ erred in awarding past medical expenses to Mr.
Evans because those expenses had been paid by CIGNA, Mr. Evans’ health insurer,
which insured him through a group health plan to which IP had contributed. The
right to a medical expense offset is governed by La.R.S. 23:1212, which reads, in
Except as provided in Subsection B, payment by any person or
entity, other than a direct payment by the employee, a relative or friend
of the employee, or by Medicaid or other state medical assistance
programs of medical expenses that are owed under this Chapter, shall
extinguish the claim against the employer or insurer for those medical
expenses. This Section shall not be regarded as a violation of R.S.
23:1163. If the employee or the employee's spouse actually pays
premiums for health insurance, either as direct payments or as itemized
deductions from their salaries, then this offset will only apply in the
same percentage, if any, that the employer of the employee or the
employer of his spouse paid the health insurance premiums.
The WCJ found that IP had not properly pleaded the offset because it listed a
number of statutory offsets that did not include La.R.S. 23:1212. In Alford v.
Acadian Ambulance Service, Inc., 96-639 (La.App. 3 Cir. 11/6/96), 682 So.2d 942,
this court ruled that the provisions of La.R.S. 23:1212 must be pleaded as any other
affirmative defense and proven by competent evidence. Further, the competent
evidence must include the percentages contributed toward the premiums by the
employee and employer.
IP maintains that it properly pleaded the defense of extinguishment. IP
pleaded several affirmative defenses. First, it pleaded the provisions of La.R.S.
23:1208 and 1208.1. These statutes govern misrepresentations concerning benefit
payments and previous injuries that might affect the employer’s ability to receive
reimbursement from the second injury fund and do not apply to Mr. Evans’ claim.
IP also pleaded benefit of credits and offsets for other amounts Mr. Evans may have
earned under the provisions of La.R.S. 23:1221(3) governing supplemental earnings
benefits, which also do not apply.
Next, IP “assert[ed] all rights to reduce benefits (if any are paid) as provided
under the Louisiana Worker’s [sic] Compensation Act, including but not limited to
La. R.S. 23:1101, 1102, 1103 [governing suits against third parties whose negligence
causes injury to a worker], 1206, 1206.1 [voluntary payments or unearned wages
paid by the employer or insurer and payments made to one of several rival claimants],
1223 [offsets for payments made], 1225 [offsets for Federal Old Age, Survivors, and
Disability Insurance Benefits or unemployment compensation benefits] and 1226
[refusal to cooperate in the vocational rehabilitation process].” These provisions
find no application to the present matter. IP pleaded the benefits of La.R.S. 23:1142,
which governs the approval of healthcare provider fees in certain situations, but not
when the employer, such as IP, has denied that the employee’s injury is compensable.
This provision is explicitly excluded from applying to the present matter.
Lastly, IP “aver[red] any and all other affirmative defenses enumerated in
Louisiana Code of Civil Procedure Article  and/or any other jurisprudentially
recognized affirmative defenses.” “An affirmative defense must be specifically pled
in the answer.” Biglane v. Bd. Of Comm’rs, Fifth La. Levee Dist., 18-100, 18-101,
p. 5 (La.App. 3 Cir. 9/26/18), 256 So.3d 1052, 1057, writ denied, 18-1767 (La.
1/8/19), 260 So.3d 588 (emphasis added). Nowhere in its answer did IP specifically
raise extinguishment as an affirmative defense. None of the affirmative defenses it
did plead relate in any way to extinguishment of the obligation to furnish medical
treatment or pay for that treatment. This assignment of error lacks merit.
IP’s third assignment of error
In its final assignment of error, IP complains of the WCJ’s calculation of Mr.
Evans’ average weekly wage (AWW) to be $1,097.69.
IP contends that the WCJ
1 This figure appears to have been based upon a “Notice of Payment, Modification,
Suspension, Termination or Controversion of Compensation or Medical Benefits” form filed by
IP’s third-party administrator, Sedgwick Claims Management Services, which states that as Mr.
impermissibly included regular and overtime pay in a manner that inflated Mr. Evans’
wages. According to IP, totaling Mr. Evans’ actual work hours over the previous
four full weeks before his injury, he did not even work a full forty hours per week:
May 16-20 40.47 hours
May 23-27 46.55 hours
May 30-June 3 24.28 hours
June 6-10 47.28 hours
Thus, multiplying his hourly pay rate, $20.78, by forty hours yields an average
weekly wage of $831.20, IP argues. However, we note that the week of May 30-
June 3 included “holiday” pay for eight hours at $20.87/ hour, and Mr. Evans did
not clock in at all on June 1, either. That is not a “full week” for purposes of
calculating AWW. See Ivory v. Sw. Developmental Ctr., 07-1201 (La.App. 3 Cir.
3/5/08), 980 So.2d 108
The intent of La.R.S. 23:1021(13)(a)(i), which governs the calculation of
AWW for hourly workers, is to approximate the average number of hours an hourly
employee works in a typical week, which is deflated when one includes a week that
includes a holiday.2
Our calculations, based solely upon the time records IP entered
into the record, do not reflect its calculations. Even IP’s time records credit Mr.
Evans for an eight-hour day on May 30, but that does not explain our differences,
either. Our review of the time records shows the following work week totals:
May 16-20 42.97 hours
May 23-27 50.05 hours
May 30-June 3 33.78 hours3
2 May 30, 2016 was Memorial Day.
Including the eight hours credited to Mr. Evans for the Memorial Day holiday.
June 6-10 52.82 hours
TOTAL 179.62 hours
Further, the payroll records show that Mr. Evans earned a “shift differential”
at times. In some periods, he was paid $20.87 per hour; at others, he earned $21.13
per hour, and yet others, he was paid $21.33 per hour. Mr. Evans’ overtime pay rate
At a minimum, though, we calculate Mr. Evans’ AWW as totaling $984.24.
Two-thirds of that exceeds the maximum weekly indemnity rate of $649.00 per week
in effect through August 31, 2016. The WCJ’s calculation of AWW was erroneous,
but that error was harmless because it does not affect Mr. Evans’ rate of
compensation. This assignment of error lacks merit.
Penalties and attorney fees
Mr. Evans appealed the WCJ’s denial of penalties and attorney fees.
Louisiana Revised Statutes 23:1201(F) governs the imposition of
penalties and attorney fees. Subsection (2) thereof exempts the
employer from penalties and attorney fees “if the claim is reasonably
controverted.” The threshold for reasonably controverting a claim is
low. A claim has been reasonably controverted when the employer
“engaged in a non-frivolous legal dispute or possessed factual and/or
medical information to reasonably counter the factual and medical
information presented by the claimant throughout the time he refused
to pay all or part of the benefits allegedly owed.” Brown v. Texas-LA
Cartage, Inc., 98-1063, p. 9 (La. 12/1/98), 721 So.2d 885, 890.
Sparrow v. City of Jeanerette, 16-656, pp. 6-7 (La. App. 3 Cir. 12/21/16), 210 So.
3d 460, 465-66. In addressing Mr. Evans’ demand for penalties and attorney fees,
the WCJ stated:
There’s no clear evidence to this Court’s view that Mr. Evans actually
reported to anyone at International Paper, “Hey, climbing those stairs,
my leg began hurting.” He just simply told them that his leg was
179.62 hours/4= 44.91 hours per week average. 40 hours @ $20.78/ hour = $831.20 +
4.91 hours @ $31.17/ hour = $153.04 overtime, for a total AWW of $984.24.
hurting on that day, and I guess they were supposed to divine from that
it must have been some activity he was performing.
Given the fact that roughly a year had passed, International Paper
was in a pretty deep hole trying to conduct an adequate investigation.
When you look at the testimonies of the co-employees and the timing
they gave about when Mr. Evans began to complain about a pain, the
fact that it was on the first floor was before he ever climbed any stairs,
and he asserts in his claim that this occurred going up and downstairs
[sic]. And then a review of the medical records indicating that there’s
no indication given to the health care providers that he hurt his leg while
performing his job activities. Now, the records do reflect his leg began
hurting three days before he sought medical care, which would have
placed him on the June 17th date of 2016, but those records don’t say
where he was when his leg started hurting. For all anyone knew from
looking at those records, his leg might have started hurting while he
was at home.
“The decision to assess penalties and attorney fees is a question of fact that is in the
great discretion of the WCJ, and it should not be reversed on appeal absent manifest
error.” Jeansonne v. Dep’t of Pub. Safety and Corr., Youth Servs., Office of Juvenile
Justice, 17-635, p. 9 (La.App. 3 Cir. 6/6/18), 247 So.3d 893, 900-01, writ denied,
18-1148 (La. 10/29/18), 254 So.3d 1209. We find no manifest error in the WCJ’s
determination for the reasons he gave and for the reasons stated above addressing
IP’s first assignment of error. The decision to deny penalties and attorney fees is
“Ordinarily, an employee is entitled to additional attorney fees for
successfully defending a workers’ compensation judgement on appeal.” Mayes v.
Deep S. Chem., Inc., 11-91, p. 6 (La.App. 3 Cir. 6/1/11), 66 So.3d 65, 70. This can
be warranted even when no penalties or attorney fees are awarded by the WCJ. See
Meche v. Gray Ins. Co., 15-465 (La.App. 3 Cir. 11/12/15), 178 So.3d 640. Mr.
Evans has successfully defended the WCJ’s judgment on appeal, and we award him
$3,000.00 in attorney fees.
Outcome: Whether an “accident” has occurred is judged from the employee’s
perspective and can include the failure of a body part that arises from and in the
course of his employment. The WCJ found that Mr. Evans proved that his left knee
fracture occurred while performing his responsibilities for IP. There is no error in
this finding. IP failed to plead the affirmative defense of extinguishment of its
obligation to pay past medicals. The WCJ relied upon the figure given by the thirdparty administrator of IP to determine Mr. Evans’ AWW; although we find this was manifestly erroneous, that error is harmless as the indemnity owed Mr. Evans for his true AWW exceeds the maximum indemnity available. We affirm the WCJ’s
decision to deny penalties and attorney fees, as IP did reasonably controvert Mr.
Evans’ claim; however, we award Mr. Evans $3,000.00 in attorney fees on appeal
for successfully defending the judgment.