Court: Louisiana Court of Appeal; May 14, 2014; Louisiana; State Appellate Court
Louis J. Bradford, representing himself, appeals a judgment from the Office of Workers’ Compensation (OWC) in favor of the Webster Parish Police Jury (WPPJ). The appeal arises from a work-related accident on December 9, 2011, where a buzzard struck Bradford's vehicle, causing injuries to his eyes. After receiving initial treatment at Minden Medical Center and subsequent care from Dr. James Swearingen, who prescribed Alrex and Bepreve, Bradford expressed dissatisfaction and requested a transfer to Dr. Bruce Henderson on March 6, 2012. Dr. Henderson prescribed an Ocudox kit, which was covered by WPPJ's insurer, but did not renew the previous medications.
In May 2012, Bradford sought refills for Alrex and Bepreve, which were denied by the insurer since his treatment had transitioned to Dr. Henderson. Bradford subsequently filed a Disputed Claim for Compensation seeking approval for these refills and benefits for an occupational disease. Following a bench trial, the workers' compensation judge (WCJ) ruled in favor of WPPJ, determining Bradford did not prove the necessity of the prior medications as required by Louisiana law, noting that Dr. Henderson did not prescribe them and that Bradford's injury was a result of an accident, not an occupational disease.
On appeal, Bradford contests the denial of medication refills and the rejection of his occupational disease claim. The appellate court applies a manifest error standard, focusing on whether the WCJ's findings were reasonable based on the evidence presented. The court emphasizes that the burden of proof and credibility assessments are within the WCJ's purview, and the manifest error standard applies even to decisions based on written evidence.
Employers are legally required to provide necessary medical treatments and expenses related to work-related injuries, as stated in La. R.S. 23:1203. A claimant must demonstrate that medical expenses are essential for treating a condition caused by a work injury, proving this necessity and the causal link by a preponderance of the evidence, as established in Pardee v. Forest Haven Nursing Home and Taylor v. Wal-Mart Stores, Inc. In the case at hand, the Workers' Compensation Judge (WCJ) reasonably denied Bradford's request to refill medications prescribed by Dr. Swearingen, as Bradford changed his treating physician to Dr. Henderson, who did not renew those prescriptions. Bradford failed to provide adequate evidence to prove the necessity for the refills, leading to the conclusion that the WCJ was not in error.
Furthermore, the WCJ's decision not to grant benefits for an occupational disease was upheld, since Bradford's injuries did not meet the statutory definition under La. R.S. 23:1031.1, though his injury is compensable under the Workers’ Compensation Act. Regarding Bradford's appeal for future medical treatment, penalties, and attorney fees, these issues were not raised at trial or in his initial claims and are thus not properly before the court. Even if they were, the law stipulates that liability for medical expenses occurs only when incurred, meaning Bradford would not be entitled to future medical benefits or fees, although he retains the right to claim such expenses in the future.
Bradford is not entitled to future medical expense awards but may claim subsequent necessary medical expenses for his work-related eye injury. Non-payment of benefits by the employer or insurer will incur penalties and attorney fees unless the claim is reasonably controverted or due to uncontrollable conditions. The term "reasonably controvert" requires the defendant to have valid reasons for denying benefits. The WPPJ successfully controverted Bradford’s claim by providing evidence that his medications were not necessary, as evidenced by his transfer to Dr. Henderson, who did not renew or deem the medications necessary. Additionally, Bradford is not entitled to attorney fees since he represented himself and incurred no legal costs. The judgment favoring the Webster Parish Police Jury is affirmed, with all appeal costs assigned to Bradford.
