Daniels v. State, Department of Transportation & Development
144 So. 3d 1123
| La. Ct. App. | 2014Background
- Daniels suffered a work-related injury Oct 28, 2010 while employed by DOTD; benefits paid without dispute.
- Surgery on Daniels’ right shoulder was performed June 13, 2011 by Dr. Brown with DOTD covering costs.
- Daniels later developed low back pain and needed/was recommended for L4-5, L5-S1 fusion; multiple opinions obtained.
- FARA denied the proposed spine surgery as not meeting the Louisiana Medical Treatment Guidelines criteria.
- A medical director denial followed (Mar. 6, 2012); Daniels filed a disputed claim for compensation (Form 1008) and the WCJ awarded the surgery but held the guidelines did not apply retroactively; this Court granted review.
- The Louisiana Supreme Court in Church Mutual Ins. Co. v. Dardar held that L.R.S. 23:1203.1 is procedural and applies to all requests after the effective date, regardless of injury date, thereby abrogating Wal-Mart’s prior position and requiring remand for proper proceedings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does 23:1203.1 apply retroactively to cases with pre-schedule injuries? | Daniels: retroactivity barred by Wal-Mart. | DOTD: rely on prior framework until proper application clarified. | Church Mutual governs; 23:1203.1 is procedural and applicable to all post-schedule requests regardless of injury date. |
| What standard of proof governs overturning the Medical Director’s denial under 23:1203.1? | Daniels contends appropriate burden is clear and convincing. | DOTD argues standard as applied by lower authorities. | Remand to apply the clear-and-convincing standard as guided by the cited authorities. |
Key Cases Cited
- Wal-Mart Associates, Inc. v. Wooden, 47,998 (La.App.2d Cir.01/22/14) (rejected retroactive application of guidelines before Church Mutual overruled)
- Church Mut. Ins. Co. v. Dardar, 13-2351 (La. 2014) (held 23:1203.1 is procedural and applies to all requests after the effective date)
- Usie v. Lafayette Parish School System, 123 So.3d 885 (La.App. 3d Cir.10/09/13) (recognizes ability to present evidence beyond medical director review)
- Bridges v. New Orleans Trucking and Rental Depot, Inc., 134 So.3d 633 (La.App. 1st Cir.12/27/13) (discusses standard of review and proof for overturning medical director’s denial)
- Vital v. Landmark of Lake Charles, So.3d -, 2014 WL 550912 (La.App. 3d Cir.02/12/14) (confirms manifest-error/clear basis for WCJ decisions and standard of review)