Hurst v. Cirrus Allied & Ky. Ins. Guaranty Ass'n

Citation: 241 So. 3d 1177Docket: NO. 2017 CA 0731

Court: Louisiana Court of Appeal; January 7, 2018; Louisiana; State Appellate Court

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Kym Hurst appeals a judgment terminating her workers' compensation indemnity and medical benefits following a back injury sustained while assisting a patient on January 6, 2010. Prior to this incident, Hurst had a history of degenerative disc disease and prior back injuries. Initially, she was awarded a lump sum of $46,192.39 for benefits through December 26, 2012, with ongoing weekly indemnity benefits starting December 27, 2012. In February 2013, Ullico Insurance Company ceased indemnity payments and was later declared insolvent, leading to the Kentucky Insurance Guaranty Association (KIGA) assuming her claim and resuming payments in May 2014.

Subsequent events prompted Cirrus Allied and KIGA to seek a modification of their obligations. Notably, Hurst was involved in an automobile accident on May 7, 2014, which she did not disclose to them, and she settled the related claim without their consent. Additionally, she was diagnosed with multiple sclerosis (MS) in July 2014 and experienced severe back pain in October 2014, which she claimed was unrelated to prior injuries.

Cirrus and KIGA filed a motion to terminate benefits, arguing that Hurst was no longer disabled from the January 2010 accident, had forfeited benefits by not seeking medical treatment, and had settled her automobile accident claim without their consent. Hurst contested these claims, asserting that she was totally and permanently disabled due to MS, which she argued was related to her work injury. A trial held on October 26, 2016, included testimonies and medical records supporting both parties' claims. The medical evidence indicated that Hurst had ongoing back pain post-accident but also highlighted her subsequent medical issues unrelated to the work injury.

In 2014, Hurst’s back pain and its connection to a 2010 work accident became ambiguous. Initially, during a visit to Dr. Hunter's clinic on February 28, Hurst indicated that her back injury had resolved after physical therapy. However, by April 24, she reported chronic lower back and neck pain to Dr. Aribbe Martin, her primary care physician. Following a subsequent automobile accident, Hurst experienced significant lower back pain but reported improvement by June 23, attributing her pain issues to the car accident, with no further treatment for back pain noted thereafter. Despite ongoing treatment for other health issues, Hurst did not seek workers' compensation for medical expenses post-May 2014, although she stated her back pain returned after being aggravated by the automobile accident.

At trial, the only medical testimony came from Dr. Hunter, who could not ascertain if Hurst remained disabled from the 2010 accident. He focused on Hurst’s diagnosis of multiple sclerosis (MS), noting it is an inflammatory condition with unclear origins and not linked to lumbar strain. His records reflected Hurst's claims that her MS was exacerbated by stress from her workers' compensation claim. The workers' compensation judge (WCJ) concluded that Hurst's current medical condition was not causally related to the 2010 accident, modifying the consent judgment to terminate her benefits and dismissing her claim for permanent total disability due to MS. Hurst appealed, contesting the WCJ's findings regarding the lack of causal connection between her MS diagnosis and the 2010 accident, as well as her entitlement to disability benefits. The case involves distinguishing between Hurst’s claims and determining the relevant legal standards and burden of proof.

Cirrus and KIGA's motion to modify a previous workers' compensation award is based on Louisiana Revised Statute 23:1310.8B, allowing for modifications due to a change in conditions. The burden of proof for such modifications lies with the moving party, requiring evidence of the change by a preponderance. The WCJ's factual determination of a change in the claimant's condition is given significant deference and is not subject to appeal unless clearly erroneous. Hurst did not contest the WCJ's finding of a change in her condition related to her work-related back injury, thus this determination is not reviewable.

Hurst's reconventional demand asserts a separate claim, requiring her to demonstrate that her multiple sclerosis (MS) was caused or aggravated by a 2010 work accident. To succeed, she must provide evidence that does not merely suggest possibility but establishes a causal connection. Hurst argues the WCJ erred in determining she failed to prove this connection. Causation is a factual issue decided by the WCJ, and under the manifest error standard, appellate review focuses on whether a reasonable factual basis exists for the WCJ's finding.

Dr. Hunter testified that the cause of MS is unknown and not linked to a lumbar strain. Although he acknowledged stress could exacerbate her condition, he did not establish a direct connection to the work accident. Hurst referenced cases where MS symptoms were aggravated by accidents, but these cases differed factually, as the claimants were actively treating for MS at the time of their accidents and experienced significant symptom flare-ups thereafter.

The work accident involving Hurst occurred nearly four years prior to her diagnosis of multiple sclerosis (MS). At the time of the accident, Hurst reported immediate low back pain and had a documented history of treatment for this condition, receiving workers' compensation benefits for several years. Dr. Hunter, who indicated that Hurst likely had MS prior to its diagnosis, provided vague testimony regarding the work accident's impact on her condition. Although Hurst experienced stress due to the suspension of her indemnity benefits, Dr. Hunter could only suggest that this stress might plausibly worsen her problems, without knowledge of her specific claim's details or other life stressors. Hurst testified that she had not faced payment issues for her disability benefits for approximately two and a half years before the trial, and Dr. Hunter's last examination of her occurred over a year prior to the trial. The burden of proof lay with Hurst to establish a causal link between her MS and the work accident, rather than the claim process. The Workers' Compensation Judge (WCJ) found insufficient evidence connecting Hurst's symptoms to the accident, leading to the affirmation of the February 9, 2017 judgment, with all appeal costs assigned to Hurst. Additionally, the court noted the dismissal of claims from Cirrus and KIGA under specific Louisiana statutes, which were not appealed. The absence of documented complaints or treatment related to back pain in recent years further supported the decision not to review the ruling.