Richard J. Borja v. Fara St. Bernard Parish Government
218 So. 3d 1
| La. | 2016Background
- Borja, a firefighter for St. Bernard Parish, filed a 2004 disputed claim for knee, heart, and lung issues arising from a June 2, 2002 injury and related occupational diseases.
- The 2004 dispute led to mediation resulting in back-pay and ongoing weekly indemnity (SEBs) at maximum benefits; a settlement/dismissal occurred on October 9, 2008.
- In November 2013 Borja filed a new disputed claim citing knee, heart, and lung injuries and seeking permanent total disability and related medical benefits.
- A workers’ compensation judge granted res judicata as to the knee and prescription as to the heart-and-lung claim in December 2014, and the court of appeal affirmed in a nonpub. opinion.
- The Louisiana Supreme Court reversed the rulings on both issues, holding that neither res judicata nor prescription barred Borja’s 2013 heart-and-lung and permanent-disability claims and remanded for further proceedings.
- The decision clarifies that indemnity payments can interrupt prescription for separate, related occupational-disease claims and that a prior dismissal does not automatically extinguish later, differently framed disability claims.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Borja’s 2013 permanent and total disability claim under the Fireman’s Heart and Lung Act prescribed. | Borja contends payments interrupted prescription and thus the claim is timely. | St. Bernard argues prescription ran, as prior benefits concluded and the 2013 claim is for a distinct, prescribed occupational claim. | Not prescribed; payments interrupted prescription for the heart-and-lung claim. |
| Whether Borja's 2013 claims are barred by res judicata due to the 2008 settlement/dismissal. | Borja asserts the 2008 dismissal did not resolve permanency issues and res judicata does not bar renewed claims. | St. Bernard argues the 2008 resolution extinguished related indemnity issues as to the knee and heart-lung claim. | Not barred; 2008 dismissal did not constitute a final judgment denying benefits or resolve all issues; res judicata does not preclude later modification or anew claim. |
| Whether Borja’s medical benefits under the heart-and-lung statute prescribed. | Borja contends medical benefits under 33:2581 were timely within the one-year/three-year framework. | St. Bernard argues medical benefits were prescribed because no post-2009 medical payments were shown under the act. | Not prescribed; medical-benefit prescription did not commence until entitlement was determined and payments were made, consistent with Perrodin and Olivier. |
| What is the proper treatment of indemnity payments in interrupting prescription for a separate heart-and-lung claim? | Indemnity payments for disability can interrupt prescription for the heart-and-lung claim. | Payments were for knee only, not for heart-and-lung disability; thus no interruption for the heart-lung claim. | Indemnity payments were for disability related to both knee and heart-lung; they interrupted prescription for the heart-and-lung claim. |
Key Cases Cited
- Giroir v. South Louisiana Medical Center, Div. of Hospitals, 475 So.2d 1040 (La. 1985) (prescription aims to protect against stale claims and lost proof)
- Lopez v. City of New Orleans, 377 So.2d 77 (La. 1979) (payments by employer do not always end prescription as to related claims)
- Leblanc v. Lafayette Consolidated Government, 983 So.2d 1022 (La. App. 3 Cir. 2008) (health-insurance payments do not interrupt prescription for workers’ compensation medical benefits under 23:1209(C) as interpreted in Leblanc)
- Olivier v. City of Eunice, 92 So.3d 630 (La. App. 3 Cir. 2012) (health insurer payment interactions with workers’ comp; solidary obligations and windfall concerns)
- Perrodin v. Lafayette City, 879 So.2d 1136 (La. App. 3 Cir. 2004) (rejects prescriptive-aid arguments; supports treatment of medical benefits under heart-and-lung statute staying proceedings until entitlement determined)
- Madere v. W.S. Life Ins. Co., 845 So.2d 1222 (La. App. 5 Cir. 2003) (modification/ongoing disability rights within workers’ comp scheme)
- Falgoust v. Dealers Truck Equip. Co., 748 So.2d 399 (La. 1999) (employees’ modification rights under workers’ comp; res judicata limits when appropriate)
- Terrebonne Fuel & Lube, Inc. v. Placid Refining Co., 666 So.2d 624 (La. 1996) (res judicata applicability in WC context; focus on scope of first action)