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Louisiana Employee’s Disputed Claim was Prescribed when Filed over Three Years from Employer’s Last Payment of Medical Benefits

In a recent opinion, the Fifth Circuit Court of Appeal upheld a judgment of the Office of Workers’ Compensation, finding that an injured employee’s claim for compensation was prescribed.  Prescription serves to limit the time period within which workers’ compensation claims may be filed, and in this case, the time period was one year following the accident or injury.  The facts of this case were unique because the employer and employee had entered into a settlement agreement, and the employee argued that he was led to believe that his employer would take care of him.  The court analyzed the four common scenarios under which contra non valentem applies, and it determined that the facts of the underlying case supported the earlier ruling that the claim was time-barred.

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In this case, the employee worked for Lowe’s Home Centers, and he was injured in April 2006 in the course and scope of his employment. Over the next six years, he received indemnity benefits ($98,746.87) and medical benefits ($127,904.25).  In August 2012, the parties submitted a petition for settlement in which Lowe’s would pay $48,500.00 to settle past, present, and future claims for indemnity benefits, as well as all past reimbursable medical costs related to the alleged accident. The settlement document made clear the parties reserved their rights as they related to the employee’s future medical benefits.

In September 2015, the employee filed a Disputed Claim for Compensation, and Lowe’s filed a peremptory exception of prescription, which was granted. The employee appealed.  The issue on appeal was whether the Office of Workers’ Compensation (“OWC”) judge had erred in holding that the doctrine of contra non valentem did not apply to the facts of this case.  In other words, the issue was whether Lowe’s exception of prescription was properly granted.

In their analysis, the court stated that Lowe’s contended the employee had not made requests for authorization of medical treatment or for processing medical bills for over three years before the disputed claim for compensation was filed.  His most recent claim for compensation was therefore prescribed under Louisiana law, which provides that claims for medical benefits shall be barred unless within one year after the accident or death, the parties agree on payments, or within one year after the accident, a formal claim has been filed.

The court stated that upon review of a peremptory exception of prescription, the appellate court must strictly construe the statutes against prescription and in favor of the claim that might be extinguished.

Here, the Office of Workers’ Compensation Judge indicated that the employee had not made a request for medical treatment since March 2012. This was before the parties agreed on a partial settlement.  The settlement had reserved claims and defenses related to the employee’s future medical treatment.  The employee had been advised of Lowe’s decision not to settle the medical portion of the claim in February 2015. The court had concluded that at the time the employee filed the current disputed claim for compensation, in September 2015, his claim for medical benefits had prescribed.

From the time of the partial settlement until September 2015, there had been no medical claim filed by the employee. Since over three years had passed from the time that Lowe’s made their final payment of medical benefits, in March 2012, the employee’s claim was prescribed on its face.

The rule, according to the appellate court, is that when a workers’ compensation claim is prescribed on its face, the claimant bears the burden of showing that the running of prescription had been suspended or interrupted.  On appeal, the employee contended that after the parties reached a settlement on indemnity, they continued the discussion regarding settling his future medical claim.  He alleged that the pending approval of the settlement “lull[ed]” him into inaction, and his disputed claim for compensation was filed within one year of Lowe’s refusal to settle. He also contended that the judicial doctrine of contra non valentem interrupted prescription.

Contra non valentem is an exception to the general rules of prescription.  In four situations, this doctrine applies to suspend the running of a prescription. These situations include a legal cause preventing the prescription from taking action, a condition coupled with contracts or proceedings that prevented the creditor from suing, a situation in which the defendant prevented the plaintiff from taking action, and a situation in which the action is not known or reasonably knowable.   The appellate court stated that contra non valentem applies only in “exceptional circumstances.”

Here, the court stated that an employee lulled into a false sense of security by the employer must show that the employer’s words or inactions caused their forbearance. In the case at hand, the appellate court stated that based on the facts, the OWC had not been clearly wrong in finding that contra non valentem did not apply. Six years had elapsed from the date of the alleged incident until the parties entered a partial settlement, and this excluded claims for the employee’s future medical benefits.  The court also stated there was no evidence explaining why the employee did not make a request for authorization of medical treatment, nor payment of medical bills after March 2012, before his claim for medical benefits prescribed three years later.

In concluding, the court stated the employee did not present evidence that Lowe’s lulled him into inaction with a promise to pay future medical expenses.  The court stated there was no basis to find contra non valentem applied, and, in the absence of a written agreement between the parties that had been approved by an OWC judge, the employee’s disputed claim was prescribed.

The court affirmed the judgment granting Lowe’s exception of prescription.

At Lavis Law Firm, our Louisiana workers’ compensation attorneys assist injured employees in pursuing their claims for benefits. Contact us online or call 866-558-9151 for a free consultation.

More Blog Posts:

Louisiana Appellate Court Lacks Subject Matter Jurisdiction in Workers’ Compensation Case Because Judgment in Favor of Employee Does Not Have Required Decretal Language to be Appealable, Louisiana Insurance & Injury Lawyer Blog

Louisiana Court Holds Clarification of Judgment is Not Modification When Injured Employee’s Payment of Medical Expenses Extinguished Claim Against Her Employer, Louisiana Insurance & Injury Lawyer Blog