CARAWAY, J.
In this workers' compensation action, summary judgment was granted against the employer and the insolvent insurer's successor, Louisiana Insurance Guaranty Association ("LIGA"), in favor of the employee who contested the termination of
While employed as a foreman with Steven Garr Logging in September of 1991, David Hollingsworth was injured when a log rolled off of a truck, hitting him in the head. In addition to head trauma, Hollingsworth also received injuries to his neck, elbow, legs, heels, back and nose and lost two fingers on his left hand. Voluntary weekly workers' compensation benefits of $240 were paid to Hollingsworth by his employer until April 12, 2010, when LIGA
On August 12, 2011, Defendants filed a motion for summary judgment on the grounds that Hollingsworth had received the statutory maximum of 520 weeks of supplemental earnings benefits (SEB) and was not permanently and totally disabled. Defendants argued that Hollingsworth's indemnity benefits were converted to SEBs on an unspecified date and that he had produced no evidence to show his permanent and total disability.
Subsequently, Hollingsworth also filed a motion for summary judgment urging recognition of his total and permanent disability and continued weekly benefits. Attached to the summary judgment were Hollingsworth's affidavit, which included a copy of LIGA's benefit termination letter, the medical records of neurosurgeon and treating physician, Dr. Russ Greer, and a copy of the report of Dr. Douglas Brown, who conducted an independent medical examination of Hollingsworth on May 9, 2011.
In his affidavit, Hollingsworth attested to the following facts:
The medical records of Dr. Greer span from September 21, 1991 through November 12, 1996. Immediately after the accident, Hollingsworth was placed in intensive care and diagnosed with head injury with small extra-axial blood collection of
By August of 1996, Hollingsworth continued to experience headaches, dizziness and neck and shoulder pain. Specifically he reported the sudden onset of a "pain in the back of the head that goes from the neck up to the back of the head" that caused him to grab his head, as well as "a sensation on the top of the head" that would last a few days. He continued the use of a walking stick for balance. Although Dr. Greer was unsure of the pathology of Hollingsworth's complaints, he noted the persistence of them since the time of the accident.
By September 1996, Hollingsworth's headaches and dizziness remained unchanged. Tests done on his cervical spine in November of 1996 resulted in the recommendation of cervical surgery including extensive decompressive cervical laminectomy and foraminotomies. Hollingsworth refused this treatment.
Orthopedist Dr. Douglas Brown, issued an independent medical examination report addressing Hollingsworth's condition on May 9, 2011. He referred to the above-noted diagnostic testing of 1996. Dr. Brown concluded that Hollingsworth suffered with herniated C3-4, degenerative C4-5, C5-6, C6-7, probable post-traumatic with foraminal stenosis, postraumatic amputation left second and third fingers, post traumatic vestibular neuronitis with secondary ataxia and imbalance and cervical spondylosis with resulting cervical loss of movement. Dr. Brown assessed Hollingsworth with a 15% whole body impairment due to the vestibular dysfunction with secondary ataxia, 38% whole body impairment due to the multi-level disc herniations and 40%. hand impairment and 22% total body impairment from the amputated fingers. Dr. Brown concluded that Hollingsworth was 100% disabled from his logging job and all jobs for which he would be qualified.
In opposition to Hollingsworth's summary judgment, the Defendants re-urged that Hollingsworth's evidence was insufficient to establish his entitlement to permanent total disability benefits. After further discovery and an IME of Hollingsworth by Dr. Randolph Taylor, Defendants supplemented their opposition to Hollingsworth's motion for summary judgment with Hollingsworth's deposition and Dr. Taylor's report.
Defendants contended that in his deposition, Hollingsworth admitted that he had
After considering the IME reports of both physicians and hearing the arguments of counsel, the workers' compensation judge ("WCJ") granted summary judgment in favor of Hollingsworth reinstating his benefits for total and permanent disability weekly benefits in the amount of $240, and assessed $8,000 penalties and $8,000 attorney fees against Steven Garr Logging due to the failure to fully investigate the termination of benefits. This appeal by Defendants ensued.
On appeal Defendants argue that the WCJ erred in granting Hollingsworth's motion for summary judgment and assessing the employer, which was uninvolved in the decision to terminate benefits, with penalties and attorney fees. Specifically, Defendants contend that the evidence submitted in support of and in opposition to the summary judgment failed to establish Hollingsworth's permanent and total disability. Defendants also argue that because of the dispute in medical evidence, the WCJ erred in not ordering a medical examination of Hollingsworth by an independent physician. Alternatively, Defendants urge that a finding of permanent and total disability was premature until Hollingsworth completes an updated rehabilitation evaluation.
Appellate courts review summary judgments de novo, using the same criteria governing the district court's consideration of whether summary judgment is appropriate. Moreno v. Entergy Corp., 12-0097 (La. 12/4/12), 105 So.3d 40. A court must grant a motion for summary judgment if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to material fact and the mover is entitled to judgment as a matter of law. La. C.C.P. art. 966(B)(2). The burden of proof remains with the movant. However, if the movant will not bear the burden of proof at trial on the matter that is before the court on the motion for summary judgment, the movant's burden on the motion does not require him to negate all essential elements of the adverse party's claim, action, or defense, but rather to point out to the court that there is an absence of factual support for one or more elements essential to the adverse party's claim, action, or defense. Thereafter, if the adverse party fails to produce factual support sufficient to establish that he will be able to satisfy his evidentiary burden of proof at trial, there is no genuine issue of material fact. La. C.C.P. art. 966(C)(2).
The clear and convincing standard in a workers' compensation case is an intermediate standard falling somewhere between the ordinary preponderance of the evidence civil standard and the beyond a reasonable doubt criminal standard. Hatcherson v. Diebold, Inc., 00-3263 (La.5/15/01), 784 So.2d 1284; Young v. Physicians & Surgeons Hosp., 39,348 (La. App.2d Cir.3/2/05), 895 So.2d 723. To prove a matter by clear and convincing evidence means to demonstrate that the existence of the disputed fact is highly probable or much more probable than its nonexistence. Young, supra.
A judgment of total and permanent disability is not indefinite. Such a finding is always subject to modification as expressly provided in La. R.S. 23:1221(2)(d). Comeaux v. City of Crowley, 01-0032 (La.7/3/01), 793 So.2d 1215; 1 H. Alston Johnson, III, Workers' Compensation Law and Practice § 275, in 13 Louisiana Civil Law Treatise (5th ed.2010). After a prior judicial determination of benefits, the employer bears the burden of proof in seeking termination or modification of benefits. Snelling Personnel Services v. Duhon, 00-661 (La.App.3d Cir. 11/2/00), 772 So.2d 350.
La. R.S. 23:1226(D) also provides:
The requirement of La. R.S. 23:1226 must be construed in pari materia with La. R.S. 23:1221(2); Comeaux, supra; Jones v. Walpole Tire Service, Inc., 38,206 (La.App.2d Cir.3/3/04), 867 So.2d 927. Unsuccessful rehabilitation attempts, including the lack of ability to be educated or retrained, along with physical incapacity, are proper factors to consider in determining whether a claimant proved his permanent and total disability. Comeaux, supra; Dennis v. Boh Bros. Const. Co., 39,548 (La.App.2d Cir.4/6/05), 899 So.2d 761, writ denied, 05-1178 (La.11/28/05), 916 So.2d 145.
Regardless of the ultimate nature of the injury, the worker who meets with an accident
The Act also provides for SEBs of 66 2/3 percent of the difference between the employee's pre- and post-injury average monthly wages for injury which prevents the employee from earning 90 percent or more of wages at time of injury. La. R.S. 23:1221(3)(a). The right to receive SEBs is limited to 520 weeks in La. R.S. 23:1221(3)(d) and this limitation underlies the dispute surrounding the Defendants' termination of Hollingsworth's benefits.
The voluntary payment of benefits by an employer does not constitute an admission of liability under La. R.S. 23:1204. Stonetrust Commercial, Ins. Co. v. George, 46,560 (La.App.2d Cir.9/28/11), 81 So.3d 9; Snelling, supra. Although the workers' compensation law allows an employer or employee to file a claim to resolve disputes, it is not legally necessary that the employer file a 1008 form requesting permission to terminate benefits that are being paid voluntarily. The employer may terminate voluntary payments at will and with impunity, provided the termination is not arbitrary and capricious. Stonetrust, supra; Snelling, supra. The employer that chooses not to terminate benefits through the filing of an 1008 form puts itself at risk of having to pay penalties and attorney fees. If the employer sues to terminate benefits, it does not have the burden of proving that the benefits were not due, even though it is the plaintiff in the litigation. Snelling, supra; Alston, supra, § 285.
An employer may not shift an employee's indemnity benefits from temporary total disability to supplemental earnings benefits in the absence of an appropriate justification. Key v. Monroe City School Bd., 45,096 (La.App.2d Cir.3/10/10), 32 So.3d 1144; Glover v. General Motors, 38,805 (La.App.2d Cir.8/18/04), 880 So.2d 172. When an employee has suffered a compensable injury under the Act, which precludes the employee from earning wages equal to wages earned prior to the injury, the employee shall be entitled to prompt rehabilitation services. La. R.S. 23:1226. This requirement has been referred to as a "statutory obligation" of the employer. Frith, supra.
The voluntary payments by Defendants of two-thirds of Hollingsworth's average wages commenced at the time immediately after the accident when Hollingsworth was completely disabled and unable to work. The evidence also indicates that following
With this situation, we find that the most important inquiry concerning Hollingsworth's status involves the initial five years of treatment by Drs. Greer and Danna. The reports of their treatment and Hollingsworth's testimony demonstrate to us that there was clear and convincing evidence to establish that Hollingsworth remained totally disabled from working. He was disabled by the combination of various factors, including the permanent injury to his hand, his cephalgia and head injury syndrome, and his spinal injuries. Significantly, Defendants did not produce any evidence of efforts to perform rehabilitation services.
With this finding measured by Hollingsworth's medical and work status in the 1990s after the accident, the Defendants produced no evidence demonstrating a shift of that status whereby Hollingsworth became able again to work. Only then might the voluntary wage benefits be considered as SEBs. With Defendants' primary argument being the payment and satisfaction of their obligation for SEBs over ten years, they did not establish when Hollingsworth's permanent total disability ended and the statutory 10-year period began.
The second issue concerns the WCJ's award of penalties and attorney fees against the employer. LIGA was not assessed for these punitive measures because of its exemption from such measures recognized under the jurisprudence. Defendants assert that LIGA alone implemented its decision to terminate Hollingsworth's benefits.
La. R.S. 23:1201(1)
The Louisiana Supreme Court has determined that LIGA cannot be assessed with penalties and attorney fees for purposes of the workers' compensation statutes because penalties and attorney fees are not "covered claims" under the Louisiana Insurance Guaranty Law, La. R.S. 22:2051 et seq.,
The ruling in Bowens, supra, excluding LIGA from liability for penalties and attorney fees rested on the following conclusion:
Id. at 1005 (emphasis in original). With this recognized distinction, we find that the employer remains responsible for timely and reasonable compliance with the obligations of our workers' compensation law and therefore may be penalized for the termination of payment of wage benefits in this case. The cessation of the payments to Hollingsworth in this case was arbitrary and capricious. The judgment of the WCJ assessing penalties and attorney fees against the employer, Steven Garr Logging, is affirmed.
For the foregoing reasons, the judgment of the WCJ is affirmed. Costs of this appeal are assessed to Defendants.