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Louisiana Appellate Court Affims Compensable Accident Took Place and Claimant Entitled to Benefits, Employer Must Pay Penalties for Failing to Reasonably Controvert Claim

The Louisiana Fourth Circuit issued a recent opinion in a workers’ compensation case following an attack on a special education teacher by an autistic boy at her school.  The court addressed whether school roomthe lower court properly awarded benefits and whether the employer reasonably controverted her claim. The court focused on the facts demonstrating that the employer had not timely reported the accident to their insurance carrier, and at the same time, the employer had not authorized medical treatment for Ms. Verges, even though she would otherwise have been eligible.  The appellate court here affirmed the finding of the trial court, in favor of the injured employee and her right to penalties and attorney fees under Louisiana law.

Shawn Verges worked at Fannie C. Williams Charter School, operated by Community Leaders Advocating Student Success (“CLASS”).  On March 26, 2015, a seven-year-old autistic boy attacked and injured her while she was in the course and scope of her employment. After the incident and on the same day, Ms. Verges reported the incident by text message to the administrative assistant to the principal, asking that an accident report be made.   Ms. Verges went to the hospital with complaints of pain to her back, head, and cervix. She then filed a disputed claim form.  Ms. Verges testified about the incident and her treatment, as well as her physical condition. She admitted to having prior medical conditions.

Procedurally, the workers’ compensation judge found Ms. Verges to be a credible witness and found that she had suffered an accident while working with CLASS at Fannie C. Williams School and was disabled as a result.  She had been denied medical treatment, and when she tried to receive treatment with a private health insurance company, her treatment was denied because it was based on a workers’ compensation accident and injury. The defendants were ordered to pay benefits to Ms. Verges and to provide all reasonable and necessary compensation related to her medical treatment.  They were also ordered to pay penalties and attorney fees for the unreasonable handling of her claim.  The defendants appealed.

The appellate court stated the standard of review in a workers’ compensation case involves first finding there is a reasonable factual basis for the trier of fact’s findings, and then determining whether the record establishes that these findings arenot manifestly erroneous.  A workers’ compensation claimant must prove that an accident took place and that the resulting disability is related to an on-the-job injury. Here, a student attacked Ms. Verges in her class. A paraprofessional witnessed the attack, and Ms. Verges reported the attack by text on the same day.  She repeatedly asked that an accident report be filled out.

The appellate court stated that after the attack, Ms. Verges went to the hospital, complaining of lumbar, head, and cervical pain. She then went to Louisiana Health Solutions and complained about her injuries.  The court also stated there had not been countervailing medical evidence.

The appellate court also noted that after Ms. Verges’ claim was denied, she tried to use her private health insurance for treatment, but since the treatment was seen to be based on a workers’ compensation claim, she was not allowed to do so.  Regarding her work, since Ms. Verges could not work in her primary job, she was earning less than 90% of her pre-incident wages and, the court stated, was entitled to supplemental earnings under Louisiana law.  The court concluded that the lower court properly held that a compensable accident took place, that the claimant had been disabled, and that the claimant was entitled to indemnity benefits.

Next, the court turned to whether Ms. Verges’ right to compensation had been reasonably controverted.  Under Louisiana law, the issue is whether the employer or its insurance company took part in a non-frivolous legal dispute of fact or medical information during the time that it did not pay some or all of the benefits.  An employer that does not authorize a medical procedure for an employee who would otherwise be eligible for that procedure is deemed to have failed to furnish benefits, and this triggers the penalty provisions under Louisiana law.

Here, medical records supported Ms. Verges’ version of events. The principal admitted to knowing about the incident on the day after it took place, and and while she understood some version of an accident took place, she did not report the incident to the workers’ compensation carrier until April 7, 2015.  Ms. Verges had repeatedly requested an accident report, and the principal did not comply.  The appellate court stated that these circumstances made clear the principal and CLASS did not assist Ms. Verges and did not reasonably controvert her claim for benefits.  It was reasonable, the appellate court held, for the trial court to award $8,000 in penalties and $15,000 in attorney fees.

The appellate court affirmed the judgment of the trial court, except for the award of assault pay, which they reversed because they stated the trial court did not have authority to award this under Louisiana law.

At Lavis Law, individuals injured in the course and scope of their employment can gain a better understanding of their rights under Louisiana workers’ compensation law.  Our office helps injured workers and their families pursue compensation for work-related injuries. Contact our office for a free consultation at 866-855-9151.

More Blog Posts:

Louisiana Appellate Court Affirms Judgment in Favor of Employee Who Inadvertently or Inconsequentially Misrepresented Previous Back and Neck Issues, Louisiana Insurance & Injury Lawyer Blog

Louisiana Appellate Court Affirms Finding that Injured Airplane Mechanic Offered Credible Testimony of His Work-Related Accident and Suffered Compensable Injury, Louisiana Insurance & Injury Lawyer Blog

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