Baton Rouge, LA (WorkersCompensation.com) – The insurance carrier for a Louisiana trucking company was entitled to reimbursement from the state’s second injury fund when two work-related injuries left a truck driver totally disabled.
Upholding a lower court’s $231,046.26 award to the carrier, the Louisiana Court of Appeal determined in Nationwide Agribusiness Insurance Company v. State of Louisiana Worker’s Compensation Injury Board, No. 2019 CA 1101 (La. Ct. App. 06/18/20), that the state’s second injury board’s arguments about the award didn’t hold up.
A truck driver was involved in a vehicular accident while in the course and scope of his employment, injuring his lower back and right hip and keeping him out of work for more than a month. Roughly a year later, while at work, the driver’s left knee gave way as he was stepping down stairs, and he ruptured his left quadriceps tendon.
According to a doctor, the latter injury caused the former injuries to “flare up.” The doctor opined that the driver’s pre-existing back and hip injuries merged with the subsequent knee injury to create a greater disability. The doctor concluded that the driver was totally disabled as a result.
The carrier paid the driver $245,000 to settle all of his workers’ compensation claims. The carrier sought reimbursement from the second injury fund for benefits it paid as result of the merger of the driver’s two job-related injuries. The board denied the carrier’s petition. The carrier took the case to court, and the court awarded reimbursement of $231,046.26, which was the sum of workers’ compensation benefits the carrier paid less deductibles set out under state law.
The board appealed.
As in other states, Louisiana has a second injury fund under which the carrier of an employer who knowingly employs or retains an employee with a permanent partial disability may be reimbursed from the fund. Reimbursement will occur if the employee experiences a subsequent injury arising out of and in the course of his employment resulting in liability for disability due to the merger of the subsequent injury with the preexisting permanent partial disability.
In Louisiana, a carrier seeking second injury fund reimbursement must show three things:
- The employee had a preexisting permanent partial disability at the time of the subsequent disability.
- The employer had actual knowledge of the employee’s preexisting permanent partial disability before the injury that formed the basis of the compensation claim occurred.
- The permanent partial disability merged with the injury to produce a greater disability.
The appeals court held that the lower correctly determined that the carrier made these showings and should be reimbursed from the second injury fund for $231,046.26. Specifically, the carrier was entitled to be reimbursed for indemnity benefits in the amount of $159,733.84 and “reasonable and necessary workers’ compensation medical benefits,” which were $71,312.42.
The appeals court also rejected an argument from the board that it should have been allowed to “audit” the medical expenses the carrier paid to determine whether they were “reasonable and necessary.” According to the court, the board had a chance to make that case at the lower court level but didn’t.
“[T]he medical expenses paid by [the carrier] were included in its motion for summary judgment,” the court reasoned. “Nothing precluded the [b]oard from filing an opposition challenging such expenses or from conducting such audit prior to the hearing.”
Finding no error in the lower court’s decision on whether the carrier was entitled to reimbursement from the second injury fund and what the amount should be, the appeals court affirmed the decision and award.