Indemnity Limited with Continued Work by Claimant:

Claimant slipped and fell at work injuring her back and hip on November 26, 2011.  Employer accepted the claim and paid indemnity benefits from May 15, 2013 through October 16, 2013.  Claimant thereafter filed a Disputed Claim for Compensation seeking indemnity benefits, medical treatment, penalties, and attorney fees.  At trial, it was found that Claimant’s initial physician found no basis to restrict her work activity.  Further, Claimant testified that she was able to work for 18 months following the accident by using medication.  It wasn’t until Claimant began seeing another physician that she was restricted from work.  The worker’s compensation judge found that Claimant failed to present any evidence of a significant change in her circumstances from when she saw the first doctor until she was restricted from work.  In regard to medical treatment, the Medical Director determined that lumbar epidural steroid injections (LESI) were not medically necessary.  However, the judge found that the Medical Treatment Guidelines reflect that the injections proposed by Claimant’s second physician were accepted and well-established procedures for treating chronic pain disorders.  The judge ruled that Claimant was entitled to LESI therapy, but was not entitled to indemnity benefits, penalties, or attorney fees.  Both parties appealed.

The appellate court noted that the standard of review was manifest error in workers’ compensation cases.  In such cases, the reviewing court’s job is not to decide whether the lower court was right or wrong, but whether the findings were reasonable.  A claimant seeking temporary total disability benefits bears the burden of proving that he or she is physically unable to engage in any employment.  La. R.S. 23:1221(1)(c).  The appellate court found that the evidence clearly demonstrated that Claimant was able to perform her job for over a year after the accident, and that the workers’ compensation judge was not manifestly erroneous in finding that Claimant failed to meet her burden by clear and convincing evidence.

A claimant may recover medical treatment that is reasonably necessary for the treatment of a medical condition caused by a work injury.  La. R.S. 23:1203(A).  Employer contended that the only evidence in favor of the necessity of the LESI was from Claimant’s second physician who only treated Claimant after her attorney was retained.  The appellate court noted that Claimant repeatedly complained of pain to her physicians, and the Medical Treatment Guidelines provide for LESIs as a treatment option for chronic pain.  Thus, the workers’ compensation judge was not manifestly erroneous in finding that Claimant met her burden.  Both rulings of the workers’ compensation judge were affirmed.

Sanchez v. Caesar’s Entertainment, Inc. (La. App. 2 Cir. 2015)

work injury

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