Court: Louisiana Court of Appeal; November 24, 2015; Louisiana; State Appellate Court
Kendall Co. Inc. is appealing a Worker’s Compensation Judge's (WCJ) decision that awarded Bruce McCoy, Jr. supplemental earnings benefits (SEBs) following a work-related injury. McCoy, employed as a driver/groundsman, suffered a head injury when a tree fell on him on March 20, 2013. He was treated for headaches, neck pain, and a skull fracture, receiving medical care and indemnity benefits. Following the incident, McCoy began treatment with Dr. Clyde Elliot, who noted no skull fractures and only mild soreness related to McCoy's pre-existing scoliosis. Despite ongoing issues, including headaches and right-hand numbness, a functional capacity evaluation conducted on July 10, 2013, indicated McCoy could handle heavy workloads.
On August 5, 2013, neurosurgeon Dr. Donald Smith evaluated McCoy, suggesting that some of McCoy's disabilities might stem from conditions unrelated to the accident, confirming that McCoy had reached maximum medical improvement (MMI) and could return to work. However, on August 29, Dr. Elliot, while agreeing with Dr. Smith's conclusion, expressed concerns about McCoy's ability to sustain work as indicated by the functional capacity evaluation. Dr. Elliot assessed that McCoy could perform some job functions but should avoid heavy lifting and activities above shoulder level, explicitly stating that he should not engage in tasks like tree climbing.
On September 11, 2013, McCoy consulted with Dr. Brian Bulloch regarding his Chiari malformation after being declared at Maximum Medical Improvement (MMI). Dr. Bulloch confirmed that an MRI from April 23, 2013, indicated successful decompression of the malformation and showed no spinal cord compromise. He believed McCoy could return to work with Functional Capacity Evaluation (FCE) restrictions. On August 21, 2013, Kendall offered McCoy a groundsman position, which he did not accept, leading to the termination of his indemnity benefits on September 6, 2013. McCoy's request to return to work in November 2013 was denied based on Dr. Smith's findings regarding his preexisting conditions, which Kendall did not have at the time of the job offer. McCoy filed a disputed claim for compensation, seeking Supplemental Earnings Benefits (SEBs), and was awarded $18,821.89 for SEBs through July 2014 and ongoing benefits from August 1, 2014. Kendall appealed, arguing that the trial court misinterpreted evidence regarding McCoy's partial disability stemming from the March 20, 2013, accident, suggesting his ongoing issues were due to preexisting conditions. McCoy contended that he was symptom-free prior to the accident but experienced significant limitations afterward. The appellate court follows a manifest error standard, assessing whether the factfinder's conclusions were reasonable based on the evidence, allowing for different interpretations without reversal if the findings align with the record.
An employee is entitled to worker’s compensation benefits for personal injuries resulting from a work-related accident, defined as an unexpected event causing identifiable injury. The employee must prove, by a preponderance of the evidence, that the injury is causally connected to the accident, though exact cause of the disability is not required. A claimant can demonstrate this connection by showing good health prior to the accident and subsequent onset of disabling symptoms, supported by medical evidence indicating a reasonable possibility of causation. Preexisting conditions do not preclude recovery if the accident aggravated or accelerated the condition. To establish aggravation, the employee must show disabling symptoms were absent before the accident, appeared after, and there is evidence of a causal link. Once this presumption of causation is established, the opposing party must prove it is more likely that the accident did not contribute to the disability. Determinations of credibility and burden of proof are factual matters for the Workers' Compensation Judge (WCJ), who holds greater authority in evaluating witness credibility than appellate courts. Generally, a treating physician's testimony is given more weight than that of a physician who examines a patient infrequently, but the WCJ must consider all medical testimonies.
McCoy, 19 at trial, was diagnosed with scoliosis at age 13 and underwent two surgeries related to scoliosis and a Chiari malformation before his employment with Kendall. He testified that after these surgeries, his only restriction was against playing football, and he performed his job without any restrictions, even volunteering for overtime. Following a March 20, 2013, accident, he worked as a cashier and sales representative but could only manage one day as a driver at Choice Brands due to the heavy lifting required.
Dr. Elliot, McCoy's family practitioner, recognized his preexisting scoliosis and surgeries but did not indicate any aggravation from the accident, noting only mild soreness and a post-concussion headache. Post-accident, Dr. Elliot treated McCoy for headaches, right-hand numbness, and constipation, with no prior evidence of these symptoms. Dr. Bulloch confirmed McCoy’s Chiari malformation had been properly decompressed and showed no significant spinal issues on MRI. Dr. Smith acknowledged the possibility of the accident aggravating McCoy’s spinal conditions but found no evidence of such aggravation. He noted that McCoy's complaints post-accident could result from the incident rather than preexisting conditions.
The Workers' Compensation Judge (WCJ) valued the opinions of Dr. Elliot, the treating physician, as more credible. Despite McCoy's preexisting conditions, he was able to perform his job without symptoms before the accident. The WCJ concluded that McCoy established a causal link between his disability and the accident, and this conclusion was upheld as not manifestly erroneous. The assignment of error regarding causation was deemed without merit.
Kendall challenges the Workers' Compensation Judge's (WCJ) determination that McCoy is entitled to Supplemental Earnings Benefits (SEBs), which are designed to compensate for lost wage-earning capacity due to a work-related injury. Under Louisiana law, an employee qualifies for SEBs if they cannot earn 90% or more of their average pre-injury wage. Initially, the employee must demonstrate this inability by a preponderance of the evidence, with the court favoring liberal construction in favor of worker’s compensation coverage. Once the employee meets this burden, the employer must then prove, also by a preponderance of the evidence, that the employee can perform a specific job that is available in the community. Actual job placement is not required; rather, the employer must show the existence of a suitable job within the employee's physical capabilities and a corresponding wage.
In McCoy's case, Dr. Elliot did not clear him to return to work until September 6, 2013, after Kendall's job offer on August 21, 2013. McCoy had requested to return to work in November 2013, but this was denied by Kendall based on medical findings that McCoy should not perform certain job duties due to preexisting conditions. The WCJ determined that this denial hindered Kendall's ability to demonstrate that McCoy was physically capable of the offered job. The WCJ found sufficient evidence from Dr. Elliot and Dr. Bulloch to support McCoy's claim that he could not earn 90% of his pre-injury wage. Consequently, the WCJ's decision to award SEBs to McCoy was affirmed, with appeal costs assigned to Kendall.
