Louisiana Commerce & Trade Association Self-Insured Fund VS Jose H. Cruz
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STATE OF LOUISIANA COURT OF APPEAL FIRST CIRCUIT NUMBER 2009 CA 2014 LOUISIANA COMMERCE TRADE ASSOCIATIONSIF SELF INSURED FUND VERSUS K JOSE H CRUZ Judgment Rendered May 7 2010 Appealed from the Office of Workers Compensation District 6 Docket Number 0903201 Honorable Gwendolyn F Thompson Workers Compensation Judge Presiding Patrick H Patrick Counsel for PlaintiffAppellant New Orleans LA Louisiana Commerce Trade Association SIF C Ray Murry Counsel for DefendantAppellee Slidell LA Jose H Cruz BEFORE WHIPPLE HUGHES AND WELCH JJ WHIPPLE J Appellant Louisiana Commerce Trade Association SIF Louisiana Commerce appeals a judgment of the Office of Workers Compensation OWC maintaining an exception of prematurity filed by appellee Jose H Cruz and dismissing without prejudice Louisiana Commerce claim for s controversion of the employee sentitlement to benefits For the following reasons we affirm FACTS AND PROCEDURAL HISTORY On April 2 2009 Mardi Gras Productions Inc Cruz employer at s the time of the injury in question and Louisiana Commerce the workers compensation insurer of Mardi Gras Productions filed a disputed claim for compensation seeking a determination that Cruz was no longer entitled to SEBs or other workers compensation benefits which they had been voluntarily paying him In their claim Mardi Gras Productions and Louisiana Commerce alleged that on May 8 2007 Cruz while discarding old carpet as an employee of Mardi Gras Productions Inc fractured his left hip when another employee pulled the piece of carpet upon which Cruz was standing causing Cruz to fall approximately eight feet Mardi Gras Productions and Louisiana Commerce further alleged that at the time of the filing of their disputed claim Cruz was being paid more than the maximum percentage of wages to which he was entitled in that he was capable of working at 90 or more of his pre injury average weekly wage They based this assertion on their allegation that Cruz had neither sought nor received medical treatment since early 2008 Cruz responded by filing exceptions of prematurity no right of action and no cause of action Cruz also sought sanctions in the form of attorney s fees In support of his exceptions Cruz argued that LSA R 23 S 1314 2 provides the exclusive list of grounds upon which a disputed claim can be filed and that the filing of a petition shall be premature unless one of those four enumerated grounds are alleged to support the claim According to Cruz Mardi Gras Productions and Louisiana Commerce had failed to plead any of these specifically enumerated allegations Cruz further asserted that if Mardi Gras Productions and Louisiana Commerce believed that Cruz was not entitled to the compensation they were paying him their remedy was to stop paying compensation at that rate and to file the requisite Form 1003 stating the reason for the change in compensation rate rather than to file a disputed claim at a time when benefits were still being paid for the improper purpose of attempting to force Cruz to prematurely propound discovery and proceed with litigation Cruz further argued that if an employer were allowed to proceed in this fashion by filing a disputed claim when benefits were still being voluntarily paid the employer would be able to force the employee to bear the cost of litigation while the employer seeks an advisory response from the OWC as to the disability status of an injured employee Accordingly Cruz averred that Mardi Gras Productions and Louisiana Commerce engaged in abuse of process by forcing Cruz into litigation of this claim prematurely and that sanctions should therefore be imposed pursuant to LSAC art P C Following a hearing on the exceptions and motion for sanctions the A Form LWCWC 1003 is a stop payment form by which the employer or insurer formally advise the OWC and the employee that the employer or insurer is terminating benefits and the reason therefor See LSAR 23 and Glover v S 1201 H General Motors 38 La App 2 805 Cir 8 880 So 2d 172 173174 04 18 Additionally a Form LWC WC1002 is to be utilized by the employer or insurer to notify the OWC and the employee of any modification in the payment of benefits such as a reduction in payments or a change to SEBs See LSA R 23 and Comeaux S 1201 H v City of Ville Platte 617 So 2d 1313 1317 La App 3 Cir 1993 3 OWC judge maintained Cruz exceptions of no right of action no cause of s action and prematurity and dismissed the disputed claim of Mardi Gras Productions and Louisiana Commerce without prejudice However the judgment was silent as to and thereby denied Cruz request for sanctions s in the form of attorney fees From this judgment Louisiana Commerce s appeals contending that the OWC judge erred as a matter of law in 1 dismissing the disputed claim of Mardi Gras Productions and Louisiana Commerce filed in accordance with LSAR 23 23 and S 1310 1310 3 1314 23 when the disputed claim alleged that the employee was not being paid maximum percentage of wages to which employee is entitled but rather he is being paid more and 2 finding that the disputed claim of Mardi Gras Productions and Louisiana Commerce which alleged that the employee was being paid more than the maximum percentage of wages to which he was entitled failed to state a bona fide dispute under LSA R S 1310 23 and 23 Cruz answered the appeal contending that the 3 1310 OWC judge improperly ruled that he was not entitled to sanctions in the form of attorney fees for the unwarranted filing of the disputed claim and s further seeking damages and attorney sfees for frivolous appeal DISCUSSION Exception of Prematurity In the instant case the judgment on appeal maintained Cruz s exceptions of no right of action no cause of action and prematurity However the statutes cited by Cruz in support of his exceptions actually address therein the prematurity of a workers compensation claim Thus we will first consider whether the OWC judge erred in dismissing without prejudice the claim of Mardi Gras Productions and Louisiana Commerce on the basis that the claim was premature 11 Workers compensation law sets forth that either the employee or the employer or insurer may file a claim with the OWC to resolve a dispute arising between the parties See LSAR 23 The statute provides S 1310 A that i f a bona fide dispute occurs the employee or his dependent or the employer or insurer may file a claim on a form to be provided by the director LSA R 23 emphasis added Additionally LSA S 1310 A S 1310 R 23 provides that a claim for benefits the controversion A 3 of entitlement to benefits or other relief under the Workers Compensation Act shall be initiated by the filing of the appropriate form with the office of workers compensation administration Emphasis added Nonetheless LSA R 23 sets forth pleading requirements for a S 1314 petition filed pursuant to LSA R 23 and provides therein that ifthe S 1310 3 petition does not include one of the four presented scenarios all of which relate to situations wherein the employer has failed to meet its obligations under the Workers Compensation Act the petition shall be dismissed as premature Specifically LSAR 23 provides as follows S 1314 The presentation and filing of the petition under R S 3 1310 23 shall be premature unless it is alleged in the petition that 1 The employee or dependent is not being or has not been paid and the employer has refused to pay the maximum percentage of wages to which the petitioner is entitled under this Chapter or 2 The employee has not been furnished the proper medical attention or the employer or insurer has not paid for medical attention furnished or 3 The employee has not been furnished copies of the reports of examination made by the employer medical s practitioners after written request therefor has been made under this Chapter or 4 The employer or insurer has not paid penalties or s attorney fees to which the employee or his dependent is A entitled B The petition shall be dismissed when the allegations in Subsection A of this Section are denied by the employer and 5 are shown at a time fixed by the workers compensation judge to be without reasonable cause or foundation in fact C The workers compensation judge shall determine whether the petition is premature and must be dismissed before proceeding with the hearing of the other issues involved with the claim Emphasis added Thus as noted by the Fourth Circuit LSAR 23 and S 1310 A A 3 1310 23 clearly purport to allow both employees and employers or insurers to bring a claim before the OWC but the pleading requirements of LSA R 23 do not reflect this dual ability to bring an action S 1314 See Michaels Store Inc v Hart 2001 0655 La App 4th Cir 3 815 So 02 20 2d 201 203 204 Both the Fourth and Fifth Circuits have addressed the anomaly created by the current versions of LSAR 23 and S 1310 3 1314 23 as they apply to employers and insurers and have concluded reading the clear wording of the statute that LSAR 23 applies S 1314 equally to employer initiated LDOL WC1008 forms Clement v Blanchard 2005 531 La App 5 Cir 2 924 So 2d 295 297298 06 14 Bank One v Johnson 2004 0508 La App 4 Cir 8 882 So 2d 30 04 11 32 33 As noted by those courts a trial court duty is not to make law but s merely to implement preexisting law in the current proceeding Clement 924 So 2d at 297 Michaels Store Inc 815 So 2d at 204 We agree with the Fourth and Fifth Circuits that any inconsistency in these workers compensation statutes as applied to employers is a matter for the legislature not the courts to correct An attempt by this court to reconcile the statutes at issue would require either the deletion or the addition of substantive language to one of the statutes Clearly this is the job of the legislature not the courts Accordingly under the clear wording of LSAR 23 Mardi Gras Productions and Louisiana Commerce in S 1314 M order to survive an exception of prematurity had to plead one of the four scenarios listed therein Indeed as noted by counsel for Louisiana Commerce at oral argument Louisiana Commerce does not argue herein that the pleading requirements of LSA R 23 do not apply to it as an insurer Rather S 1314 it asserts that even applying the mandatory pleading provisions of LSA R S 1314 23 the claim filed herein by Mardi Productions and Louisiana Commerce met those pleading requirements Specifically Louisiana Commerce notes that the LDOLWC1008 form filed by Louisiana Commerce and the employer contained the following allegation Employer and carrier allege employee is not being paid maximum percentage of wages to which employee is entitled rather he is being paid more Louisiana Commerce asserts that the allegation that Cruz was being paid more than that to which he was entitled equates to or encompasses the allegation that Cruz was not being paid maximum percentage of wages to which he is entitled Thus Louisiana Commerce contends that it pleaded the specific scenario set forth in LSA R 23 and accordingly that the S 1314 1 A OWC judge erred in dismissing the claim as premature Louisiana Commerce further argues that allowing it to proceed with its claim while it continues to pay benefits to Cruz fosters the policies of the workers compensation statutory scheme by encouraging voluntary payments to a The 2 LDOLWC 1008 form is a Disputed Claim for Compensation form 3A further support for its contention that the OWC judge erred in dismissing its claim Louisiana Commerce cites the First Circuit opinion of Our Lady of Lake Regional Medical Center v Matthews 20061584 La App 1 Cir 9971 So 2d 354 356 07 26 wherein an employer while continuing to pay benefits brought an action seeking a determination that the employee was no longer disabled However the issue of prematurity and the applicability of LSAR 23 to employer and insurer S 1314 A initiated claims was not before the court in that case If the objection of prematurity is not raised by the timely filing of a dilatory exception the exception is waived Wilson v St Mary Community Action 20002106 La App I Cir 12 803 So 2d 1106 01 28 1111 1112 Thus Matthews is inapposite to the prematurity issue raised herein 7 claimant While we recognize Louisiana Commerce sattempt to artfully argue its claim to fit within the confines of the pleading requirements of LSAR S Awe cannot agree that an allegation that a claimant is being paid 1314 23 more than the maximum weekly benefits to which he is entitled encompasses the allegation that he is not being paid the maximum amount to which he is entitled Rather if a claimant is being paid more than the maximum to which he is entitled he also is necessarily being paid the maximum percentage of wages to which he is entitled Thus we find no merit to the argument that the claim filed by Louisiana Commerce and Mardi Gras Productions met the pleading requirements of LSA R S 1314 23 Accordingly applying LSA R 23 to the disputed claim S 1314 filed by Louisiana Commerce and Mardi Gras Productions we must conclude that the OWC judge dismissal of the claim without prejudice on s the basis of prematurity was correct Exceptions of No Right of Action and No Cause of Action In dismissing the claim filed by Louisiana Commerce and Mardi Gras Productions the OWC judge also maintained Cruz exceptions of no right s of action and no cause of action As stated above these exceptions were based upon the same argument concerning the applicability of LSAR S A 1314 23 to employer and insurer initiated claims Because we have determined that the OWC judge did not err in dismissing without prejudice the petition of Louisiana Commerce and Mardi Gras Productions on the 4 I so concluding we note as did the OWC judge that our holding herein does not leave an employer or insurer without a remedy where it has determined that the employee is being overpaid benefits Rather the employer or insurer has non judicial remedies as outlined in footnote one supra of reducing or terminating the payment of benefits where the employer or insurer has actually determined that a modification is warranted unlike the circumstances presented herein 0 basis of Cruz exception of prematurity we pretermit discussion of the s remaining exceptions as moot Sanctions In his answer to appeal Cruz contends that the OWC judge erred in failing to award sanctions in the form of attorney fees pursuant to LSA s P C art 863 He further requests that this court award him sanctions against Louisiana Commerce for frivolous appeal However given the apparent inconsistency or lack of clarity in the above cited workers compensation statutes we decline to award the relief sought by Cruz in his answer to appeal CONCLUSION For the above and foregoing reasons the August 4 2009 judgment of the OWC dismissing without prejudice the claim filed by the employer and its insurer is affirmed Costs of this appeal are assessed against Louisiana Commerce Trade Association SIF AFFIRMED This 5 court has applied the provisions of LSA C art 863 to workers P compensation claims See Bracken v Payne and Keller Company Inc 20060865 La App I Cir 9 970 So 2d 582 590591 07 5 E
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