Case Name: Linda S. KELLY, Plaintiff-Appellant, v. CNA INSURANCE COMPANY, et al., Defendants-Appellees
Court: Louisiana Court of Appeal
Jurisdiction: Louisiana
Decision Date: 1998-01-23
Citations: 706 So. 2d 198
Docket Number: No. 29455-CA
Parties: Linda S. KELLY, Plaintiff-Appellant, v. CNA INSURANCE COMPANY, et al., Defendants-Appellees.
Judges: Before MARVIN, C.J., and NORRIS, HIGHTOWER, BROWN, WILLIAMS, STEWART, GASKINS, CARAWAY and PEATROSS, JJ.
Reporter: Southern Reporter, Second Series
Volume: 706
Pages: 198–203

Head Matter:
Linda S. KELLY, Plaintiff-Appellant, v. CNA INSURANCE COMPANY, et al., Defendants-Appellees.
No. 29455-CA.
Court of Appeal of Louisiana, Second Circuit.
Jan. 23, 1998.
Travis M. Holley, Bastrop, for Plaintiff-Appellant.
Jan P. Christiansen, Monroe, for Defendants-Appellees.
Before MARVIN, C.J., and NORRIS, HIGHTOWER, BROWN, WILLIAMS, STEWART, GASKINS, CARAWAY and PEATROSS, JJ.

Opinion:
I2NORRIS, Judge.
The plaintiff, Linda Kelly, appeals a judgment sustaining -the defendants' exception of no cause of action and dismissing her suit. Because of conflicting authority from this court, the matter was referred to an en banc hearing. URCA Rule 1-5. For the reasons expressed, we now affirm but remand the case to the District Court to grant Ms. Kelly the opportunity to amend her petition to state a cause of action.
Ms. Kelly, an industrial worker, filed this tort suit against her employer, Shield Pack, and, its insurer, CNA Insurance Co., alleging that because of the repetitive nature of her work, she developed a condition known as carpal tunnel syndrome bilateral epicondyli-tis. She further alleged that she underwent surgery to treat the condition and then re turned to her old job at Shield Pack. Resumption of work, however, caused a recurrence of her pain. CNA placed her on workers' compensation weekly and medical benefits for a period of time, but then, "for no reason whatsoever," terminated these benefits. She further alleged that this action devastated her financially, east her into clinical depression and made her suicidal. She specifically alleged that CNA and Shield Pack knew of her deteriorating condition but took no steps to assist her; continuing to withhold benefits, they aggravated her condition. In addition to her mental condition, Ms. Kelly alleged that the defendants' action caused her physical condition to deteriorate for lack of proper care. She concluded, in ¶ 11, that the worsening of her condition resulted from "either intentional conduct on the part of the Defendants or conduct that they should have known would cause Petitioner's injury to worsen, and that this worsening is separate and distinct from the injury sustained on the job."
|3The defendants filed an exception of no cause of action, alleging that Ms. Kelly's exclusive remedy was under the Louisiana Workers' Compensation Act, and that they were entitled to tort immunity under the act. La. R.S. 23:1032; Rusher v. Winningham Nissan Volvo Inc., 550 So.2d 784 (La.App. 2d Cir.1989).
The District Court sustained the exception and dismissed the suit. On appeal, Ms. Kelly urges this was error because of the holding of Weber v. State, 93-0062 (La.4/11/94), 635 So.2d 188.
In Weber, a worker sustained an occupational disease,' and his doctors told him his only hope of survival was to have a heart transplant. The employer refused to authorize the transplant, but the Office of Workers' Compensation recommended payment. Before the worker could seek judicial review, he died. His survivors filed a tort suit for wrongful death; the employer filed an exception of no cause of action, which the District Court and the Court of Appeal sustained. The Supreme Court, however, reversed. It held that the employer's "alleged conduct in intentionally and arbitrarily denying necessary medical expenses," if proved, "may result in liability for damages beyond the remedies provided in the Workers' Compensation Act[.]" The court held that such damages were appropriate when the conduct and the resulting injury did not occur in the course of employment and only marginally arose out of employment, "and when the employer knew to a substantial certainty the denial would cause death that would not otherwise have occurred."
Apparently because the case was one in which death had intervened, the Supreme Court specifically reserved the decision on whether the exception would apply if the employer denied payment of necessary medical expenses despite knowledge "that a significant worsening of the employee's condition is substantially certain to follow." Id., at p. 10, 635 So.2d at 194, fn. 9.
1/This court initially visited the issue in Berry v. Insurance Company of N. Amer., 28,580 (La.App.2d Cir. 10/30/96), 683 So.2d 310, writ denied 97-0091 (La.3/7/97), 689 So.2d 1374. The plaintiff in Berry suffered from work-related reflex sympathetic dystrophy; he had requested, and the insurer had refused to provide, experimental treatment which allegedly would have prevented the plaintiff from losing the use of his leg. The plaintiff contended that his allegations stated a cause of action for a tort claim based on a non-fatal condition, the issue reserved in Weber, supra. This court found that on the allegations made, the penalty and attorney fee provision of the Compensation Act, R.S. 23:1201 E and 1201.2, provided a sufficient remedy for the plaintiff. The court declined to extend Weber to cover the non-death claim, and sustained the exception of no cause of action.
The court then re-visited the issue in Stevens v. Wal-Mart Stores Inc., 29,124 (La. App.2d Cir. 1/24/97), 688 So.2d 668, writ denied 97-0671 (La.5/9/97), 693 So.2d 768. In that case the plaintiff injured his shoulder while on the job; although the employer initially denied his compensation claim, a Workers' Compensation Hearing Officer declared that the injury was work-related and ordered the employer to pay weekly and medical benefits. While a suspensive appeal was pending, the plaintiffs treating physician advised the employer that immediate physical and mental treatment was necessary to avert further, irreversible deterioration and possible suicide. As in Berry, swpra, the plaintiff countered the employer's exception of no cause of action by urging that his allegations were sufficient under Weber. A different panel of this court agreed, noting that although the specific holding in Weber was narrow, "we find the reasoning [in Weber ] persuasive, at ieast to the extent that we are constrained to find that plaintiffs have stated a cause of action."
IsWe now address the issue for the third time. As the Supreme Court noted in Weber, R.S. 23:1032 is an immunity statute, and it must be strictly construed against the party seeking the immunity. See also Roberts v. Sewerage & Water Bd., 92-2048 (La.3/21/94), 634 So.2d 341. Every presumption must be indulged on the side of preserving the general tort rights of an injured worker against the actual wrongdoer, in the absence of explicit statutory language limiting or excluding such rights. Id. In our view, the interests that the Supreme Court acknowledged and preserved in Weber, a death case, may arise in a non-death case such as Stevens, supra, or the instant case. We find that these interests are no less worthy of preservation in a non-death case. In the absence of clear legislation to reverse the holding of Weber, we will recognize the jurisdiction of the District Court to hear tort eases in which the plaintiffs entitlement to tort-based remedy is properly alleged.
Applying the rationale of Weber, we hold that the injured employee states a tort cause of action when he alleges (1) he suffered what is not disputed to be a compen-sable injury; (2) intentional and arbitrary refusal to pay reasonable and necessary medical expenses results in a significant, immediate deterioration of his health; (3) this result would not have occurred otherwise and could not have been averted by recourse to the Act; and (4) the employer or insurer knew that such results were substantially certain to follow from the refusal to pay.
The exception of no cause of action tests the legal sufficiency of the petition; it is tried on the face of the petition and, for purposes of determining the issues raised by the exception, the well-pleaded facts in the petition must be accepted as true. La. C.C.P. art. 927; Roberts v. Sewerage & Water Bd., supra The general rule is that an exception of no cause of action must be overruled unless the allegations of the petition exclude every reasonable hypothesis other | gthan the premise on which the defense is based, ie., unless the plaintiff has no cause of action under any evidence admissible under the pleadings. Id.; Haskins v. Clary, 346 So.2d 193 (La.1977). Every reasonable interpretation must be accorded the allegations in favor of maintaining the sufficiency of the petition and affording the litigant the opportunity to present his evidence. Jarrell v. Carter, 577 So.2d 120 (La.App. 1st Cir.), writ denied 582 So.2d 1311 (1991).
When the grounds of an exception of no cause of action may be removed by an amendment of the petition, the judgment sustaining the exception shall order that such amendment be made within a specified time. La. C.C.P. art. 934; Robinson. v. North American Royalties Inc., 470 So.2d 112 (La. 1985); Goodwin v. Agrilite of Louisiana, 26,061 (La.App.2d Cir. 9/21/94), 643 So.2d 249.
In sum, we conclude that an injured employee may state a Weber cause of action in a non-fatal case. We further conclude that Ms. Kelly has not made the appropriate allegations to state this cause of action. We therefore affirm the judgment sustaining the exception of no cause of action, but remand the case to allow Ms. Kelly to amend her petition, if possible, to state a cause of action in accord with this opinion. Such amendment is to be filed with the District Court within 15 days of the rendition of this opinion. Costs of this appeal are assessed 50% to Ms. Kelly and 50% to the defendants; further costs are to be assessed by the District Court.
AFFIRMED AND REMANDED.
BROWN, J., concurs with written reasons.
CARAWAY, J., dissents with written reasons.
HIGHTOWER, J., dissents for reasons assigned by CARAWAY, J.
GASKINS and PEATROSS, JJ., dissent.
. Stevens v. Wal-Mart Stores, Inc., 29,124 (La. App.2d Cir. 1/24/97), 688 So.2d 668, writ denied 97-0671 (La.5/9/97), 693 So.2d 768; Berry v. Insurance Company of N. Amer., 28,580 (La. App.2d Cir. 10/30/96), 683 So.2d 310, writ denied 97-0091 (La.3/7/97), 689 So.2d 1374.
. The defendants filed a peremptory exception of res judicata in this court on June 24, 1997. In light of our holding that Ms. Kelly has not yet stated a cause of action, we decline to address the subsequent exception. That exception is remanded to the District Court for disposition in the event that Ms. Kelly's amended petition successfully states a cause of action.