Case Name: Linda Miles STEVENSON v. The BOLTON COMPANY, INC. and Fireman's Fund Insurance Company
Court: Louisiana Court of Appeal
Jurisdiction: Louisiana
Decision Date: 1985-12-26
Citations: 484 So. 2d 678
Docket Number: No. CA 84 0414
Parties: Linda Miles STEVENSON v. The BOLTON COMPANY, INC. and Fireman’s Fund Insurance Company.
Judges: Before COLE, CARTER, LANIER, CRAIN and JOHN S. COVINGTON, JJ.
Reporter: Southern Reporter, Second Series
Volume: 484
Pages: 678–698

Head Matter:
Linda Miles STEVENSON v. The BOLTON COMPANY, INC. and Fireman’s Fund Insurance Company.
No. CA 84 0414.
Court of Appeal of Louisiana, First Circuit.
Dec. 26, 1985.
Decree Amended On Rehearing March 31, 1986.
Writ Denied June 6, 1986.
Paul Due’ and Benjamin Guelfo, Charles Wm. Roberts, Baton Rouge, for plaintiff-appellant Linda Miles Stevenson.
Carolyn Perry and Carey T. Jones, Baton Rouge, for defendants-appellees The Bolton Co., Inc.; et al.
Before COLE, CARTER, LANIER, CRAIN and JOHN S. COVINGTON, JJ.

Opinion:
JOHN S. COVINGTON, Judge.
The primary issue presented in this appeal is whether there was a causal connection between plaintiffs work accident and her subsequent disability. The primary issue presented in the answer to this appeal is whether the insurer's failure to commence compensation payments timely was justified.
Plaintiff, Linda Miles Stevenson, was injured on October 30, 1980 while acting in the course of her employment with The Bolton Company as a plasterer's apprentice on a renovation project at LSU. On that date plaintiff stepped into a hole on the second floor of the building being renovated and fell in a straddled position, with one leg in and one leg outside the hole. As a result of this accident, plaintiff sustained an injury to her lower back and hip.
Plaintiff immediately reported the accident to her employer, but declined an offer to see a physician on that date, stating she preferred to see a physician only if it became absolutely necessary. Plaintiff did not work the day after the accident, but returned to work the following Monday, Tuesday and Wednesday. On November 6, 1980, she decided to see the company doc tor because her pain had become unbearable. She thereafter was referred to several doctors and underwent various tests, treatments and therapy for her injury.
Plaintiff had been released to return to work by two physicians by the end of June 1981. However, she felt she was still unable to work because of the severity of the pain she continued to experience. At that time she was under the care of Dr. Kenneth Adatto, an orthopedic surgeon, whom she had first consulted on May 18, 1981. Even after being released by her other physicians, plaintiff continued treatment with Dr. Adatto which culminated in surgery on her lower back on September 18, 1981. In the course of this surgery Dr. Adatto discovered and corrected a forami-nal decompression, which he concluded was the source of plaintiffs problems. Although plaintiff improved substantially after her surgery, the operation left her with a permanent 10% disability.
On the basis of her work injury, plaintiff received worker's compensation benefits from the date she stopped working until sometime in June of 1981. Upon the termination of her benefits plaintiff filed suit for worker's compensation, medical expenses, penalties and attorney fees against her former employer, the Bolton Company, Inc., and its insurer, Fireman's Fund Insurance Company. Trial of this matter commenced on October 18, 1982 and continued for three days. The trial was then recessed until November 19, 1982 at which time counsel made their ¿rguments before the court, after which this matter was taken under advisement. On September 5, 1983 the court rendered judgment dismissing plaintiff's claim for additional worker's compensation benefits. The court also denied plaintiff's claim for the cost of medical services, hospitalization and surgery prescribed by Dr. Adatto. However, the court granted plaintiff's claim for penalties and attorney fees. Plaintiff perfected an appeal from this judgment. Defendants thereafter filed an answer to plaintiff's appeal seeking reversal of the award for statutory penalties and attorney fees, claiming it was unwarranted and excessive.
In order to recover worker's compensation benefits, the plaintiff must prove the following chain of causation; his employment caused an accident, the accident caused his injury and the injury caused his disability. La.R.S. 23:1031; Shatoska v. Intern. Grain Transfer, Inc., 430 So.2d 1255 (La.App. 1st Cir.1983). Although it is necessary for the plaintiff to prove his disability and its causal relation with his employment accident, it is not necessary he prove the exact cause of his disability. Walton v. Normandy Village Homes Association, Inc., 475 So.2d 320 (La.1985). In the absence of proof showing an intervening cause, an employee's disability is presumed to result from the accident, if he was in good health before the accident, but after the accident disabling symptoms appear and continuously manifest themselves, provided the medical evidence shows a reasonable possibility of a causal connection between the accident and the disability. Walton, supra; Robertson v. Scanio Produce, 449 So.2d 459 (La.1984). Once the plaintiff establishes the basic facts giving rise to this presumption, a heavy burden of proof is shifted to the defendant to prove by a preponderance of the evidence the absence of any correlation between the work injury and the employee's disability. Walton, supra; Hammond v. Fidelity & Cas. Co. of New York, 419 So.2d 829 (La.1982). In Walton, supra, the Louisiana Supreme Court stated:
"Once the disabled employee establishes the presumption of a causal relationship, the party denying the existence of the presumed fact assumes both the burden of producing evidence and the burden of persuasion on the issue.
The effect of the presumption is not so slight and evanescent that it is spent and disappears upon the mere produc-, tion of evidence by the adversary. It is a true presumption which has been ere-' ated for policy reasons that are similar to and just as strong as those that underlie the compensation principle itself: the probability of the causal connection un der the circumstances which give rise to the presumption, the difficulty of proving causation with testimony by medical experts often sharply divided by differing schools of opinion, and the desirability of reducing the margin of error inherent in litigation as to a disabled employee, both because he has at stake an interest of transcending value — his and his family's livelihood — and because those persons who enjoy the product of a business should ultimately bear the cost of injuries or deaths that are incident to the manufacture, preparation and distribution of the product." (Citations omitted.) (Emphasis added.)
A plaintiff in a worker's compensation case is entitled to this presumption of causation even where he was not entirely symptom free before the accident. Walton, supra. Because an employer takes his employee as he is, recovery is not precluded if the accident activated or precipitated disabling manifestations of the pre-existing condition. Id.
In the present case, it is undisputed plaintiff suffered a work related accident. In addition, defendants do not seriously contest the claim plaintiff now suffers from at least a 10% permanent disability. The decisive issue herein is whether there was a causal connection between plaintiff's work accident at LSU and her subsequent disability.
Plaintiff argues she is entitled to the aforementioned presumption of a causal connection between her work accident and her subsequent disability. In opposition to this claim, defendants made two basic arguments. First, they argue this presumption is not applicable because plaintiff was not in "good health" prior to the LSU accident, having had an extensive history of back problems and injuries similar in nature to the injury of which she now complains. Second, defendants maintain any disability suffered by plaintiff as the result of the LSU accident was temporary and had ended by June 23, 1981. They argue plaintiff's permanent disability was completely unrelated to her work accident, being the direct result of the unnecessary back surgery performed in September of 1981, after she had already recovered from any disability caused by her work accident at LSU.
One of the primary reasons for the trial court's judgment was its negative assessment of plaintiff's credibility. The court refused to accept plaintiff's testimony that she began experiencing disabling back pain shortly after the LSU accident, which continued until her back surgery.
It is well established a plaintiff in a worker's compensation case will be deemed a malingerer only upon clear and convincing evidence. Long v. Moses Motor Hotel, Inc., 460 So.2d 1156 (La.App. 2d Cir.1984); Caston v. Combined Insurance Company of America, 308 So.2d 287 (La.App. 1st Cir.1975). (The physicians who testified at trial indicated they had no reason to doubt the genuiness of plaintiff's complaints of pain.) In fact the record is devoid of any evidence which would support the conclusion plaintiff was a malingerer.
Further, our examination of the record also fails to support the reasons given by the trial court for its adverse credibility determination. For instance, in its written reasons the trial court stated one of plaintiff's co-workers testified plaintiff had complained of back pains from October 22, 1980, the date she returned to work following an automobile accident, through October 30, 1980, the date of the LSU accident. However, our review of the pertinent testimony reveals plaintiff's co-worker never testified plaintiff complained of back pains, but only that she complained of pain in her leg and knee.
We find the trial court also misconstrued the record when it stated plaintiff's testimony contained an admission she had lied while giving a pre-trial statement to an adjuster regarding prior injuries. The particular testimony in which plaintiff used the work "lied" must be taken in context. The colloquy in which this term occurred was a discussion of the fact plaintiff had given inaccurate information to an adjuster as to which of her legs had been injured in a previous accident. Plaintiff candidly admitted her error, stating:
"... I probably did say that. It was on that tape, so, yes, I admit it. But like I say, we were in a heated argument beforehand, so I probably just forgot a few details but it was my left leg, my left knee, because that is what I went to the hospital for pain in the upper part of my neck because of...."
"Q. But when you were taped, and this is the transcript, I show you the transcription of that tape that says it was my right leg.
A. Well, it wasn't in my right leg. If I said .
Q. But that is what you said on the tape.
A. —that, I lied, but I didn't lie deliberately. It was just a mistake. " (Emphasis added.)
It is clear to this court plaintiffs use of the word "lied" was merely her characterization of having made a mistake and not of having intentionally told an untruth. This statement was taken on January 21, 1981, a considerable time after the accident had occurred and after medical treatment had been completed. Since this injury was insignificant, it is quite understandable plaintiff, at the time of the statement, could not recall which leg or knee was involved. As to plaintiffs credibility, we find no intentional misrepresentation on her part so as to warrant the conclusion she was being untruthful. Finally, a review of the entire direct and cross-examination of plaintiff, including most of the questioning conducted by the trial court itself, simply does not support the conclusion plaintiffs testimony was untruthful or evasive.
For these reasons we are compelled, despite the great weight accorded to such matters, to reverse the credibility determination made by the trial court in the present case.
We now turn to the trial court's finding on the issue of causation. In support of their argument plaintiff was not entitled to the benefit of a presumption of causation because she was not in good health prior to the LSU accident, defendants direct the court's attention to several prior occasions when plaintiff sought medical treatment, allegedly complaining of back pain. The trial court accepted defendant's argument, finding plaintiff was not in good health prior to the LSU accident and thus was not entitled to a presumption of causation.
Although it is clear plaintiff had several accidents and medical problems pri- or to the LSU accident, it is far from clear whether any of these problems were related to her lower back. None of plaintiff's previous accidents or problems were similar in nature to the injury of which she now complains. The majority of these complaints were made in connection with gynecological problems. Further, plaintiff testified the type of pain she experienced on these occasions was entirely different from the pain she experienced following the LSU accident. Even if plaintiff had previously complained of lower back problems, the evidence does not establish any such problem was ever found prior to the LSU accident. To the contrary, our examination of the pre-accident medical evidence revealed a total absence of any evidence suggesting the existence of any type of lower back pathology, injury or disability.
However, even if it could be said plaintiff's condition was pre-existing, application of a presumption of causation is not precluded if the condition was precipitated into disabling manifestations as a result of the work accident. In the instant case, there is absolutely no evidence plaintiff was unable to perform her regular job duties, which included a large amount of stooping, bending and climbing, prior to the LSU accident. Even though plaintiff was involved in a vehicular collision shortly before her LSU accident, the evidence does not establish she was unable to perform her regular duties upon her return to work following this automobile accident. Although one of plaintiffs co-workers testified plaintiff complained of pain upon her return to work, these complaints were specifically related to plaintiffs leg and knee, rather than her back. Given the fact we have found no evidence of any back pathology or disabling symptoms prior to the LSU accident, but commencing with the accident disabling symptoms have continuously been manifested, we conclude plaintiff is entitled to the presumption of a causal connection between the LSU accident and her subsequent disability.
Plaintiff having proven the basic facts giving rise to this presumption, it became incumbent upon defendants to prove by a preponderance of the evidence the absence of any correlation between plaintiffs work injury and her disability. Walton, supra. Defendants attempted to carry this burden by showing plaintiffs disability actually resulted from unnecessary back surgery performed on September 18, 1981, rather than from the LSU accident. The trial court found plaintiff could be denied recovery based on its conclusion this surgery was unnecessary and broke the chain of causation and legal responsibility. However, Louisiana jurisprudence recognizes that if subsequent medical malpractice or excessive medical treatment occurs, the plaintiff is entitled to recover either in a tort case against the tortfeasor, or in a worker's compensation case against the employer and insurer. In both situations the tortfeasor and the employer and insurer have at their disposal the right to then sue the doctor either for recovery based on the extent to which the compensation responsibility or tort damages have been augmented owing to such malpractice or for reimbursement of the excessive cost for treatment. As stated by the court in Fruge v. Hub City Iron Works, Inc., 131 So.2d 593 (La.App. 3d Cir.1961), at p. 597:
"Further, when the medical treatment for the accidental injury is cause in fact of the final condition of the employee, such residual is in itself considered a result of the accident and therefore com-pensable, even where (which we of course we do not imply to be the case here) caused subsequent to the accident by negligent treatment. See Malone, Louisiana Workmen's Compensation (1951), § 233 (p. 282)."
See also, Thibodeaux v. Potomac Insurance Company, 201 So.2d 159 (La.App. 1st Cir.1967).
Logically, if a defendant in a personal injury or wrongful death tort suit cannot escape liability for subsequent medical malpractice suffered by the accident victim, by claiming such constituted a break in causation, a fortiori, a worker's compensation defendant should not, and cannot escape liability on this basis, particularly considering the liberal purpose and intent of coverage of worker's compensation to the benefit of the employee. In fact, even if plaintiff had received nothing more than diagnostic services, such medical expenses would still be recoverable, even though only for diagnostic purposes and even though the expenses were incurred after the last date of disability that was found to exist. Dyson v. Travelers Insurance Company, 256 So.2d 468 (La.App. 4th Cir.1972); cf. also Sanders v. Western Casualty & Surety Company, 337 So.2d 286 (La.App. 2d Cir.1976).
Accordingly, it is not necessary for this court to decide whether the surgery in question was essential. The proper forum in which this issue should be decided would be in a suit by the worker's compensation insurer against the physician performing the surgery, after invoking the necessary review panel procedure. Plaintiff has admittedly suffered a permanent, partial disability of at least 10% as assigned by defendant's expert witness or 10% to 15% as assessed by plaintiffs expert witness. We find the trial court erred as a matter of law in failing to award plaintiff compensation benefits for her permanent partial disability, as well as the cost of medical services, hospitalization and surgery prescribed by Dr. Adatto.
The final issue for our consideration is the trial court's award of statutory penalties and attorney fees. In its answer to plaintiff's appeal, defendants assert this award was unwarranted and excessive. To the contrary, plaintiff maintains the $5,000.00 award for attorney fees was inadequate and should be raised to $10,000.00.
The purpose of the penalty and attorney fee provision of the worker's compensation law is to require the employer or the insurer to pay timely the benefits owed to the employee and to avoid the necessity of the employee retaining the services of an attorney to file suit. It has been recognized that even though the penalty statute speaks in terms of the requirement of 60 days notice, the absence of written notice to an employer of compensable injury cannot prevent collection of penalties where the employer had actual and immediate knowledge of the claimant's injury, and its refusal to pay benefits was not based on absence of notice. Saltalamacchia v. Strachan Shipping Corporation, 156 So.2d 291, (La.App. 4th Cir.1963), reversed on other grounds, 246 La. 91, 163 So.2d 548 (La.1964). In Lee v. National Tea Company, 378 So.2d 134 (La.App. 3d Cir.1979), the Third Circuit held a self-insured employer, which was aware of the claimant's disability but failed to obtain any medical advice as to the cause of the disability, was liable for penalties and attorney's fees for failure to pay benefits.
Notice to the employer is construed as notice to the insurer for purposes of invoking penalties and attorney's fees in worker's compensation cases. La.R.S. 23:1162 C; Antoine v. Houston Fire and Casualty Company, 232 So.2d 588 (La.App. 3d Cir.1970). In order to invoke penalties and attorney fees it is not necessary that proof of loss be in writing or any other formal manner as long as the defendant has actual knowledge of the facts. Id.
Although plaintiff's disability began on October 30, 1980, the insurer did not begin compensation payments until January 22, 1981. Fireman's Fund's claims supervisor, Mr. Kinney, admitted the employer's first report of injury which was dated November 11, 1980, was received shortly thereafter. This form indicated disability began on the date of the accident and also stated plaintiff had an appointment with Dr. Dejean on that same November 11, 1980. Mr. Kinney stated no action was taken on this claim until January 8, 1981 because the report was misplaced for almost two months.
Mr. Kinney initially attempted to attribute the delay in commencing compensation to information in the file reflecting plaintiff's earlier automobile accident. However, he was later forced to admit information as to this automobile accident was not even in the file in the beginning and was not the basis for the delay in paying compensation. Mr. Kinney also admitted the confusion or miscommunication between plaintiff's employer and Fireman's Fund was not attributable to plaintiff in any way. Additionally, there was no medical report at the time justifying the delay.
In Whatley v. The Lummus Company, 243 So.2d 922 (La.App. 3d Cir.1970), penalties and attorney fees were held to be properly imposed where it took the insurer eight weeks to get the claimant's file returned from the home office. In Hale v. Courtney Equipment Company of Alex andria, 410 So.2d 1258 (La.App. 3d Cir.1982), it was held that failure to satisfactorily explain why benefits were not timely paid resulted in proper imposition of a $5,000 attorney fee award. The misplacement of the employer's first report of injury for some eight weeks, resulting in a deprivation of weekly compensation to the plaintiff is equally egregious.
In this case, after the insurer finally commenced payment of the initial compensation benefits by check dated January 22, 1981 for 77 days compensation, it once again stopped paying weekly benefits and did not pay these back benefits until almost two months later on March 16, 1981. The only proffered justification for not paying compensation was an alleged return to work note by Dr. Dejean.
The law is clear that plaintiff has no requirement to make excessive "proofs of loss" or demands for payment for resumption of payments. In Chavis v. Maryland Casualty Company, 307 So.2d 663 (La.App. 3d Cir.1975), writ denied, 310 So.2d 854 (La.1975), penalties and attorney's fees were assessed even though no formal demand for resumption of payments was made. The court stated:
"To interpret the law otherwise would permit an insurer to discontinue payments repeatedly, force the employee after discontinuance to make demand and then wait nearly sixty days thereafter to bring payments up to date or force the plaintiff to litigate."
To the same effect, see Maricle v. Cloud, 341 So.2d 29 (La.App. 3d Cir.1976).
Regardless of the report of Dr. Dejean, when Fireman's Fund only a few days later received the report from Dr. Bolton, dated January 23, 1981, it was put on notice that plaintiff was still under active medical treatment and was entitled to continued compensation benefits. The contention Fireman's Fund did not know plaintiff had not returned to work is refuted in the very first portion of Dr. Bolton's aforementioned January 23,1981 report, wherein Dr. Bolton states: "She has not returned to work since the accident." From this report it is clear plaintiff had been prescribed two weeks of extensive physical therapy by Dr. Bolton, who diagnosed a lumbosacral strain and possible lumbar disc.
An insurer is required to make a reasonable effort to ascertain an employee's exact medical condition before benefits are terminated. Johnson v. Ins. Co. of N. America, 454 So.2d 1113 (La.1984). If, subsequent to an initial optimistic report, an insurer received medical information indicating continuing disability, the insurer may not blindly rely upon the earlier report to avoid penalties for arbitrary nonpayment of compensation benefits. Johnson, supra; see also, West v. Belden Corp., 396 So.2d 1004 (La.App. 3d Cir.1981), writ denied, 401 So.2d 976 (La.1981). Penalties and attorney's fees are properly awarded when an insurer discontinues compensation benefits without probable cause. Johnson, supra.
Mr. Kinney admitted no one working for Fireman's Fund or plaintiff's employer made any attempt to contact Dr. Bolton to inquire whether or not he felt plaintiff was disabled. Dr. Bolton testified at trial that plaintiff was indeed disabled from work when he saw her initially on January 23, 1981 and thereafter. Also, there was nothing in Dr. Bolton's second report to Fireman's Fund, dated February 20, 1981, which in any way would justify continued nonpayment of compensation benefits. To the contrary, this report confirmed plaintiff reported no improvement in her symptoms- and was accordingly referred by Dr. Bolton to a neurologist.
Defendant's suggestion that penalties and attorney fees are not warranted in this case because plaintiff did not communicate with her employer or Fireman's Fund, so that neither was advised she was not working until Fireman's Fund received Dr. Dejeans's report on January 8th, 1981, is totally without merit. Plaintiff's employer was well aware why she was not back at work, since it had sent her to see Dr. Dejean on November 11, 1980. Thus it then knew or certainly could have found out Dr. Dejean was treating plaintiff until the time Dr. Dejean referred her to Dr. Bolton. As previously stated, notice to the employer is construed as notice to the insurer for purposes of penalties and attorney's fees. Further, plaintiff had no means of communicating with Fireman's Fund during the initial deprivation of worker's compensation benefits, since she was unaware Fireman's Fund was her employer's compensation insurer.
The trial court was correct in awarding statutory penalties and attorney's fees predicated on not one but two inexcusable refusals to pay plaintiff timely the compensation benefits to which she was obviously entitled. Further, we agree with plaintiff's argument the attorney fees award was inadequate. Trial of this matter took three full days,. as well as an additional day for oral argument before the trial court. In addition, plaintiff was required to pursue this matter by appeal. Under the circumstances present, we find the award for attorney fees should be increased to $7,500.00.
"DECREE
The portion of the judgment appealed from which denied plaintiff's claims for additional compensation benefits and medical expenses is reversed, and judgment is hereby rendered awarding plaintiff permanent partial compensation for a period of 450 weeks, less compensation previously paid, each weekly benefit to bear legal interest from its respective due date, until paid. Judgment is further rendered for all unpaid medical expenses claimed by plaintiff, same to bear legal interest from date incurred, until paid. The portion of the trial court judgment awarding penalties and attorney fees is hereby amended to increase the award of attorney fees from $5,000 to $7,500, the $5,000 portion awarded by the trial court is to bear legal interest from the date of the trial court judgment, until paid; the $2,500 portion awarded by this court is to bear legal interest from the date of our judgment, until paid; and, further, the 12% penalty shall bear legal interest from the date of judicial demand, until paid."
REVERSED IN PART; AMENDED AND, AS AMENDED, AFFIRMED IN PART.
CARTER, J., dissents and assigns reasons.
LANIER, J., dissents for the reasons assigned by CARTER, J.
. In any event, the statement in question was an out-of-court statement on an issue collateral to the issues presented in plaintiff's suit. A trial court should not judge a plaintiffs credibility on the basis of testimony relating to a purely collateral issue. Robertson v. Scanio Produce, 449 So.2d 459 (La.1984).
. Subsequent to the LSU accident, plaintiff was involved in an automobile accident, which occurred when she backed her car into a gas pump at a convenience store. However, plaintiff stated she was only going 5 to 10 miles per hour at the time, sustained no injury and did not seek any medical treatment. This testimony is uncontradicted.
. In so stating this court does not wish to imply a belief the surgery was unnecessary. Although this court has reached no decision on this issue for the reason stated, we note there appears to be no evidence in the record sufficient to dispute Dr. Adatto's testimony that he discovered and corrected a foraminal depression during this surgery, or his final diagnosis of foraminal stenosis.