Court: Louisiana Court of Appeal; October 14, 2015; Louisiana; State Appellate Court
Appellants Lucky Coin Machine Company, Lucky Coin, and Amtrust North America appeal a workers’ compensation judgment that found claimant Nunzio Galiano had sustained a work-related injury. The court reversed the judgment.
Claimant worked for Lucky Coin for twelve years as a pool table technician, requiring him to move heavy equipment, including 200 lb. slates, up and down stairs. In late August 2013, he began experiencing low back pain but did not report it to his employer due to fear of termination. By October 2013, after performing several physically demanding jobs, his pain intensified. When he finally reported the pain, his supervisor insisted he provide a week's notice before seeing a doctor, leading claimant to cancel appointments until he could no longer tolerate the pain.
On November 6, 2013, after visiting Dr. Aarti M. Pais, claimant learned his pain was not related to kidney issues and was informed it could be work-related. Diagnosed with sacroiliac joint dysfunction, he was released to work with restrictions but was subsequently deemed unable to return by the employer’s physician. Claimant stopped working that day and later filed for workers’ compensation benefits on March 25, 2014, after receiving short-term disability and unemployment benefits.
The workers’ compensation judge (WCJ) initially ruled the injury was work-related, which appellants contested, arguing the evidence was insufficient and speculative regarding the timing and cause of the injury. After a trial, the WCJ again ruled in favor of the claimant, prompting the current appeal.
Appellants argue that the medical evidence fails to support the claimant's assertion that his back pain resulted from a work-related accident. In contrast, the claimant asserts that cumulative trauma from various jobs during the third week of October 2013 caused his back pain, preventing him from working, and claims this incident was correctly identified as a work-related accident by the workers’ compensation judge (WCJ). Additionally, the claimant references serious lumbar issues in his medical records and suggests a reasonable causal link between his injury and his job duties, particularly involving lifting heavy slates.
Under Louisiana law, a claimant must demonstrate a "personal injury by accident arising out of and in the course of his employment." An accident is characterized as an unforeseen event that produces objective injury findings, distinguishing it from gradual deterioration. The burden of proof lies with the claimant to establish a work-related accident by a preponderance of the evidence. The claimant’s testimony can suffice to establish the occurrence of an unwitnessed accident if it is not significantly contradicted and is corroborated by subsequent circumstances.
The WCJ's findings can only be overturned if deemed clearly wrong or manifestly erroneous. In this case, the reviewing court found that the WCJ erred in determining that a work-related accident occurred. The evidence raised doubts about the claimant's account, notably his failure to report a low back injury to his employer and his initial belief that the pain was unrelated to work. The claimant expressed concern about job security, yet his prior experience of receiving workers’ compensation without repercussions undermined his credibility regarding fear of termination.
Medical records do not substantiate the claimant's assertion of a work-related accident or occupational disease qualifying for workers’ compensation. There is no documentation indicating the claimant informed any physicians that his back pain stemmed from a work-related incident. Dr. Pais's reports from November and December 2013 detail the onset of pain without recalling a specific injury, while Dr. Todd's records indicate sudden lumbar pain without prior injury. Additionally, the records do not include any diagnosis linking the back pain to a work-related event. The claimant's actions also raise doubts about his credibility; he did not inform his employer of a work-related accident when seeking medical attention, instead citing kidney issues. After being advised by Dr. Pais that the pain was not kidney-related, the claimant still did not report a work-related incident. He opted to pursue short-term disability rather than file for workers’ compensation and did not apply for benefits until after his disability ended. The Workers' Compensation Judge (WCJ) was found to have committed a manifest error in ruling that a work-related accident occurred, leading to the reversal of the judgment in favor of the appellants. The appellants' claim that they failed to reasonably contest the claimant's claim was deemed moot due to the claimant's inability to prove a work-related accident.
The judgment was reversed and rendered due to insufficient evidence linking the claimant's low back pain to a work-related accident. The work restriction from Lucky Coin’s workers’ compensation physician included "no bending or twisting, no lifting," and required physical therapy, but did not specify that the back pain was a result of a work-related incident or detail the duration of the claimant's inability to work. The claimant was terminated in February 2014. Testimony from the claimant’s wife indicated that he believed his pain was kidney-related and suggested it might be work-related, but there was no definitive assertion that the pain resulted from a work-related incident. The trial's judgment did not address the potential for the pain being classified as an occupational disease, leading to a presumption of denial for that claim due to silence on the matter. The claimant failed to appeal this denial. The medical records discussed did not establish that the claimant informed his physicians that his pain was work-related, nor did the physicians conclude that it was due to a work-related accident. Overall, the evidence presented did not sufficiently support the claimant's assertion of a work-related injury.
