In a workers’ compensation case, the Fifth Circuit Court of Appeal held that a clarification of a judgment does not modify that judgment, when the phraseology but not the substance has been amended. After a complicated procedural history, the appellate court here held that the judge clarified that medical expenses shall be paid according to applicable law, and the injured employee’s payment of her expenses to her med ical insurer extinguished her claim against the defendants for those paid expenses.
Sharon Mangiaracina worked as a sales agent for defendant Avis Budget Group. While working, she fell from a chair and suffered injuries to her back, left shoulder, and thumb. She admitted that she had a pre-existing injury to her left shoulder and had received medical treatment. She also contended that the accident increased the pain in her shoulder and affected her ability to work.
Ms. Mangiaracina elected to undergo left shoulder surgery, but Avis and its workers’ compensation insurer declined to pay, asserting the need for surgery was caused by her pre-existing condition. Aetna, Ms. Mangiaracina’s health insurer, paid most of Ms. Mangiaracina’s medical bills, although she did incur some out-of-pocket expenses. She then filed a disputed claim for compensation, seeking both medical and indemnity benefits from Avis and their workers’ compensation insurance company.
A trial resulted in a finding of a causal connection between the accident and Ms. Mangiaracina’s need for surgery and her disability. Ms. Mangiaracina was awarded benefits, and the defendants were ordered to pay for medical expenses. The defendants appealed, and the award was affirmed.
The defendants then filed a Motion to Modify Judgment on the ground that the parties had not agreed about what would constitute satisfaction of the judgment, specifically since Aetna had paid for Ms. Mangiaracina’s surgery and treatment. They contended they should be entitled to an offset for the payments Aetna had already made.
Ms. Mangiaracina opposed the motion and argued that res judicata barred any modification of the judgment. The workers’ compensation judge heard the matter, and on January 25, 2016, he rendered a judgment granting the Motion to Modify Judgment and indicating the prior awards were being clarified to reflect that medical expenses should be paid by the defendants, and the payments made by Aetna extinguished Ms. Mangiaracina’s claim against the defendants for those expenses. Ms. Mangiaracina filed a Motion for New Trial, which was denied, and she appealed.
Here, the court agreed that the issue was how the award of medical expenses in the workers’ compensation judgment would be enforced and satisfied. The appellate court held that the judgment of January 25, 2016 clarified the terms of the prior judgment and did not alter or change the substance of the prior judgment. The defendants both remained responsible for Ms. Mangiaracina’s medical expenses.
Next, the court addressed Ms. Mangiaracina’s assertion that modifying the prior judgment to provide payment for medical expenses under the statutory fee schedule was barred by res judicata. But the court stated that the issue of whether the fee schedule applied had not in fact been decided. While res judicata bars relitigating matters that have been litigated and decided or those that should have been previously brought in an earlier case, the doctrine did not apply here. Clarifying the prior judgment to provide payment for medical expenses was not barred by the res judicata doctrine.
The court stated that Louisiana law requires employers to pay for all drugs, hospital care, and medical and surgical treatment that result from a work-related accident. Furthermore, the director of the office of workers’ compensation administration establishes and promulgates a reimbursement schedule for medical expenses, which include drugs, treatment, and supplies. Fees that are in excess of the reimbursement schedule are not recoverable against employers.
In this case, the appellate court stated that the workers’ compensation judge properly held that the defendants were required to pay for all of the medical expenses in accordance with the fee schedule. The appellate court also stated that this finding did not change the substance of the prior judgment but merely clarified that expenses are to be paid according to the law.
Finally, the court rejected Ms. Mangiaracina’s claim that she should be personally reimbursed for medical expenses she paid to Aetna, her insurance company, since Aetna could seek reimbursement from her for the amount it paid. Louisiana law holds that the payment of medical expenses extinguishes a claim against an employer or insurer for those medical expenses. The court stated that this law prevents employees from receiving a windfall from employers when their health insurance company already paid the expenses.
The court affirmed the judgment of the lower court, finding the employee’s arguments did not hold merit.
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. Contact an attorney for a free consultation at 866-855-9151.
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