Martin v. Davison Transport, Inc.
Martin v. Davison Transport, Inc.
Opinion of the Court
Plaintiff was injured in the course and scope of his employment while driving an 18 wheel tractor trailer rig. Plaintiff was paid temporary and total disability and medical benefits as a result of the injuries he sustained from the accident. Thereafter, Plaintiff filed a claim with the Office of Workers’ Compensation asserting that Defendants refused to allow him to choose his own specialist. Plaintiff also filed an amended claim, asserting that his weekly disability rate should be increased and that Defendants refused to approve necessary medical equipment for him. Then Plaintiff filed a rule to have Defendants ordered to: (1) reimburse him for a $500 medical evaluation fee; (2) assign him another case manager; (3) refrain from any further direct contact with his health care providers; and (4) pay attorney fees/costs associated with the rule. Defendants responded and stated that the rule should be denied because: (1) the assignment of a case manager is within the sole discretion of the | pemployer/insurer; (2) the current case manager should be maintained; and (3) Plaintiff failed to allege that his opportunity to receive medical treatment had been interfered with by Defendants.
After a hearing on the rule filed by Plaintiff, the Workers’ Compensation Hearing Officer ordered Defendants to reimburse Plaintiff the $500 medical evaluation fee, to replace the medical case manager, and to appoint a new medical case manager to meet with Plaintiff. The hearing officer further ordered Defendants to pay a penalty in the amount of $2,000 and to pay attorney fees in the amount of $3,000 for: their failure to timely provide
The Louisiana Workers’ Compensation Act does not provide claimants the right to a medical case manager, the selection of a medical case manager, or the termination of a medical case manager. Plaintiff has not cited nor do we find any authority which allows the Workers’ Compensation Hearing Officer to manage the operations of a medical case manager who is employed or contracted by an employer. While we agree in this case that the actions of the medical case manager may have been egregious, the proper remedy under the Workers’ Compensation Act is the imposition of sanctions in the form of penalties and attorney fees against the employer.
The legislature has remained silent on the issue of a claimant’s right to a medical case manager. Accordingly, neither Plaintiff nor the Workers’ Compensation Hearing Officer can regulate medical case management services. We therefore [.¡reverse that portion of the court of appeal’s decision directing Defendants to replace the medical case manager and to appoint a new medical case manager.
REVERSED IN PART; OTHERWISE DENIED.
Dissenting Opinion
dissenting.
The per curiam opinion is premised upon the lack of authority by the hearing officer in removing a 'particular case manager, because the Worker’s Compensation Act does not provide for this. While there is no specific law providing for the replacement of a medical case manager, it can equally be reasoned that the Act does not provide for a medical case manager in administering the medical benefits of an injured claimant. Notwithstanding these arguments, in my view, the remedy fashioned by the hearing officer was not as drastic as “selecting” or “terminating” a case manager hired by the employer, but rather ordering the employer to replace, at its choosing,
Indeed, I find that in confining the scope of its consideration to certain statutorily enumerated remedies, the court has abrogated the inherent powers of the workers’ compensation hearing officer, thereby
Previously, this court has recognized that Workers’ Compensation embodies a compromise: “Countervailing sacrifices are demanded from each party. In exchange for the limitations on the accident victim’s remedy, a strict liability system guarantees a recovery by superseding the plaintiffs prior obligation to prove negligent conduct.” Butler v. Flint Goodrich Hosp. of Dillard Univ., 607 So.2d 517, 530 (La. 1992). As part of this compromise, the procedure for an injured employee to obtain much-needed medical benefits was intended to be streamlined: “A relatively simplified claims procedure significantly benefits the plaintiff by providing a prompt and efficient mechanism for damage recovery, thereby obviating for all parties the costs and long delays of ordinary negligence litigation.” Id. (emphasis added).
While this goal of a streamlined procedure to provide benefits existed from the beginning, the reality at times proved different. Accordingly, in 1988, the legislature vested the hearing officer “with original, exclusive jurisdiction over all claims or disputes arising out of [the Worker’s Compensation] Chapter, including but not limited to workers’ compensation insurance coverage disputes.... ” La. R.S. 23:1310.3(D). This legislative grant of authority was deemed so important that after R.S. 23:1310.3 was declared unconstitutional because it infringed on the jurisdiction of the district courts,
While reviewing courts have often commented upon the limited extent of the grant of authority to hearing officers,
In this role of dispute resolution, the issue before the hearing officer was not that of exercising authority in contravention of the self-insured employer’s choice to hire a case manager, but to ensure that the injured worker received the medical benefits to which he was entitled. If it is true that a hearing officer does not render a “judgment,” only “an order, decision, or award,”
Accordingly, I respectfully dissent.
. By the time this case came before this court, Davison Transport had already replaced the case manager.
. I find it significant, as did the Court of Appeal, that the case manager that Mr. Martin sought to have replaced was the same case manager that the claimant sought to have replaced in Baird v. Policy Management Systems, Inc., 31,715 (La.App. 2 Cir. 3/31/99), 731 So.2d 461.
. See Moore v. Roemer, 560 So.2d 927 (La.App. 1 Cir. 1990).
. The legislative proposal for amendment, ultimately adopted, provided: "[E]xcept as heretofore or hereafter provided by law for administrative agency determinations in worker’s compensation matters, a district court shall have original jurisdiction of all civil and criminal matters.” Acts 1990, No. 1098, effective November 7, 1990.
. See, e.g., Whittington v. Langston Drilling Co., 26,001, p. 4 (La.App. 2 Cir. 9/21/94), 643 So.2d 336, 339: “The OWC is a legislatively-created administrative body, in which the WCHOs [hearing officers] function in a quasi-judicial capacity to settle workers’ compensation disputes.”
. Id. (emphasis in original, other emphasis in original omitted).
Reference
- Full Case Name
- Joseph D. MARTIN v. DAVISON TRANSPORT, INC. and Davison Insurance Agency, Inc.
- Cited By
- 1 case
- Status
- Published