Miken Specialties v. Abarca
209 So. 3d 268
La. Ct. App.2016Background
- On May 1, 2012 Norman Abarca was struck on the hardhat by a falling plank while working for Miken; he briefly lost consciousness and later developed neck pain.
- Abarca continued full-duty work (with overtime) until he was laid off in July 2012, then worked for a second employer from Sept. 2012–Mar. 2013.
- March 2013 consent judgment conceded the May 1, 2012 accident and a neck injury but reserved Abarca’s right to future medical and indemnity benefits; Miken reserved defenses.
- Disputes arose over entitlement to ongoing indemnity benefits and approval of cervical surgery; the Medical Director denied the requested cervical surgery on Oct. 15, 2014 (Abarca did not appeal that denial).
- After trial the workers’ compensation judge found Abarca failed to prove (1) he was unable to engage in any employment (temporary total disability) and (2) the May 1, 2012 accident caused a need for cervical surgery or for knee/lumbar treatment. Judgment dismissed claims with prejudice; this appeal followed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Subject-matter jurisdiction over surgery claim | Medical Director has exclusive jurisdiction under La. R.S. 23:1203.1; W.C. judge lacked authority to decide surgery entitlement | Trial court could decide causation (whether accident caused condition), not medical-necessity under the schedule | W.C. court had jurisdiction to decide causation and whether Abarca proved entitlement; exception denied |
| Temporary total disability (TTD) | Abarca: accident rendered him unable to engage in any employment (seeks TTD under La. R.S. 23:1221) | Miken: Abarca returned to full duty after accident and later worked for another employer; doctors found him capable with restrictions | W.C. judge not manifestly erroneous: Abarca failed to prove TTD by clear and convincing evidence; benefit denied |
| Cervical surgery / Medical Director denial | Abarca: entitled to surgery as work-related; trial court erred in finding otherwise | Miken: symptoms due to preexisting degenerative disease; surgery not caused by accident; Medical Director denied approval | Court: Abarca failed to show Medical Director erred by clear and convincing evidence; W.C. judge’s causation finding affirmed — no entitlement to surgery as injury-related |
| Knee and lumbar treatment | Abarca: accident caused knee and lower back injuries warranting treatment | Miken: complaints arose late, no contemporaneous treatment or records tying knee/lumbar to accident; degenerative findings preexisting | W.C. judge not manifestly erroneous: Abarca failed to prove causation for knee or lumbar treatment; claims denied |
Key Cases Cited
- Summers v. Ritz-Carlton New Orleans, 171 So.3d 329 (La. App. 5 Cir.) (standard for proving causation and disability in workers’ compensation)
- Vital v. Landmark of Lake Charles, 153 So.3d 1017 (La. App. 3 Cir.) (workers’ compensation court review of Medical Director decisions)
- Gilliam v. Brooks Heating & Air Conditioning, 146 So.3d 734 (La. App. 2 Cir.) (procedure for judicial review of Medical Director decisions under LAC requirements)