Louisiana Insurance Guaranty v. Weller

Citations: 977 So. 2d 29; 2007 La.App. 1 Cir. 0571; 2007 La. App. LEXIS 2047; 2007 WL 3246239Docket: No. 2007 CA 0571

Court: Louisiana Court of Appeal; November 2, 2007; Louisiana; State Appellate Court

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In a workers’ compensation case, the court upheld the findings of the workers’ compensation judge that Earl Mae Weller is no longer totally and permanently disabled and that her chiropractic care and mileage expenses were neither reasonable nor necessary. Weller was injured on April 1, 1976, while working as a waitress and initially received weekly compensation benefits and medical expenses after a trial in 1979. Following years of appeals and modifications, LIGA, as the successor to the insolvent insurer Rockwood Insurance Company, sought to terminate or modify Weller's benefits. A 1997 ruling confirmed Weller's total disability; however, this was reversed on appeal in 1998. Weller later attempted to nullify the 1997 judgment, claiming lack of subject matter jurisdiction, which resulted in the judgment being vacated in 2001. Subsequently, in 2003, both Weller and LIGA filed claims regarding her disability status. After a hearing in 2006, the workers' compensation judge ruled in favor of LIGA, determining that Weller was no longer disabled due to the 1976 accident and denied all further benefits, including medical expenses.

The judgment denied Ms. Weller's claims from her reconventional demand, with costs assigned to LIGA. The Workers' Compensation Judge (WCJ) found Ms. Weller not credible based on her testimony, demeanor, medical evidence, and a surveillance videotape showing her engaging in physical activities. The WCJ determined that LIGA demonstrated that Ms. Weller was no longer disabled from her work injury and denied her requested benefits and expenses. The WCJ also ruled that the chiropractic treatments were neither reasonable nor necessary. Ms. Weller's appeal contested the findings on her disability status and the necessity of chiropractic care, arguing that her chronic pain syndrome, resulting from her 1976 injury, prevented her from working. LIGA contended that she was not permanently and totally disabled and, if she were, her condition was unrelated to her 1976 work injury. The analysis cited that a worker is considered totally disabled only if unable to engage in any gainful occupation, referencing pertinent legal standards. The testimony of treating physicians typically holds more weight, but the credibility of expert opinions is paramount. Multiple medical evaluations indicated Ms. Weller is not permanently disabled from her 1976 injury and can work with restrictions, further supported by surveillance evidence that contradicted her claims of pain.

Surveillance footage shows Ms. Weller engaging in daily activities, such as walking and bending, without apparent discomfort. Dr. John Taylor Howe, her treating physician since 1978, is the only doctor asserting that she continues to suffer from a compensable injury preventing her from working due to chronic pain linked to a 1976 injury. Dr. Howe identified her condition as both physical and psychiatric, diagnosing chronic pain syndrome and a personality disorder. However, when presented with hypothetical scenarios reflecting her observed activities, both Dr. Howe and her chiropractor, Dr. Sidney Mouk, agreed that if she could perform those tasks, she should be capable of working. The analysis concluded that the opinions of specialist doctors were more credible than Dr. Howe's connections between the 1976 injury and her ongoing issues. The surveillance evidence and medical testimonies supported the conclusion that Ms. Weller is capable of some level of work, affirming the workers' compensation judge's (WCJ) findings on her disability status and benefits. 

On medical expense claims, an injured employee must substantiate the necessity of the medical treatment related to the work injury per LSA-R.S. 23:1203. Dr. Howe acknowledged that chiropractic treatments were likely helpful but not essential. Other chiropractic experts testified that such treatments were unnecessary beyond a short period after the injury. A review of the chiropractic bills revealed a lack of evidence for the need for ongoing care after the initial weeks. Consequently, the WCJ's denial of chiropractic and mileage benefits was upheld. The judgment was affirmed, with costs of the appeal assigned to the plaintiff, LIGA.