Court: Louisiana Court of Appeal; February 3, 2015; Louisiana; State Appellate Court
Michael Carambat, a police officer for the City of New Orleans Police Department (NOPD), sustained multiple injuries in an on-duty accident in 2007, leading to surgeries and ongoing medical treatment. After a second work-related accident in 2010, his condition worsened, resulting in further surgeries and continuous care from Dr. Carl Lowder. In August 2012, Dr. Lowder restricted Mr. Carambat to desk duty due to his medical condition. Following his release from the NOPD, a vocational rehabilitation specialist identified suitable job options for him, which Dr. Lowder approved, indicating Mr. Carambat’s potential for some earning capacity.
In February 2013, Dr. Lowder elaborated on Mr. Carambat's chronic sleep issues, attributing them to pain and medication side effects, and suggested he could perform sedentary to light duties with certain limitations. Consequently, the NOPD changed Mr. Carambat’s temporary total disability (TTD) benefits to supplemental earnings benefits (SEB), reducing his benefits based on the earnings potential from the lowest-paying approved position. Mr. Carambat contested this conversion and reduction of benefits by filing a claim with the Office of Workers’ Compensation Administration, leading to the NOPD's motion for summary judgment, which the trial court granted. However, the appellate court reversed this judgment and remanded the case for further proceedings.
The trial court determined that there were no genuine issues of material fact regarding Mr. Carambat’s ability to work, leading to the grant of the NOPD's motion for summary judgment. Mr. Carambat is appealing this decision, asserting that contested material facts exist concerning his work capacity. The appellate review of summary judgment is de novo, applying the same criteria as the trial court, which requires evidence showing no genuine issues of material fact for a motion to be granted. The burden of proof lies with the moving party, and any doubts are resolved in favor of the non-moving party. An issue is deemed genuine if reasonable individuals could disagree about it, and material facts are those that affect the outcome of the legal dispute.
To qualify for Temporary Total Disability (TTD) benefits, an employee must demonstrate, by clear and convincing evidence, that they are physically unable to engage in any employment. TTD benefits cease when an employee's condition stabilizes to allow a reliable assessment of their disability, and the employee does not require continuous medical treatment. Moreover, an employee who can return to work, even if experiencing pain, is ineligible for TTD benefits. Mr. Carambat contends that he remains entitled to TTD benefits, as the presented evidence does not confirm his ability to return to work. Alternatively, he argues that if his benefits were appropriately converted to Supplemental Earnings Benefits (SEBs), the reduction was unjustified. SEBs are designed to compensate for the loss of wage-earning capacity due to the injury, requiring proof that the work-related injury has resulted in an inability to earn 90% or more of the average pre-injury wage.
An employee must demonstrate their inability to work for an employer to recover supplemental earnings benefits (SEBs). The employer then bears the burden to prove the employee's physical ability to perform a specific job and that such a job was either offered or available in the employee's geographic area. Actual job placement is not necessary, but the employer must show: (1) the existence of a suitable job within the employee's physical capabilities in the relevant area, (2) the expected wage for someone with the employee's experience, and (3) that an actual position was available when the employee was notified of the job's existence. If the employer fails to meet this burden, the employee's SEBs are determined based on the difference between their pre-injury average monthly wage and post-injury earning capacity.
In this case, Dr. Lowder, a medical professional, acknowledged that while the claimant, Mr. Carambat, might physically tolerate a light sedentary job, his chronic pain and sleep deprivation were significant barriers to successful re-employment. Dr. Lowder noted that Carambat's sleep issues could impair his ability to work effectively. Although Dr. Lowder approved three job positions for Carambat based on his physical capabilities, he did not consider the implications of Carambat's pain and sleep issues.
Carambat testified about his difficulties related to pain and sleep, asserting that while he could perform the jobs physically, the side effects of his medication hindered his ability to work, even in a sedentary role. He also indicated that the commuting time to a job in Mandeville exceeded Dr. Lowder's recommended limit, rendering it unsuitable.
The court concluded that conflicting medical testimonies and Carambat's extensive medical history created material factual issues regarding the conversion of his benefits from temporary total disability (TTD) to SEBs, leading to the reversal of the trial court's summary judgment and a remand for further proceedings.
