Insurance Dispute Lawyer Blog

1010 Form Required For Company To Cover Medical Expenses in Workers Compensation

Published on: October 27, 2023 | By Berniard Law Firm

photo_old_old_recording_0-scaled While workers’ compensation is intended to compensate injured workers, there are a number of procedural requirements with which an injured worker must comply in order for his or her company to cover the medical treatments. This case illustrates the importance of complying with procedural requirements and submitting all required paperwork.

While working for Circle K Stores, Melody Smith went to a Capitol One bank located in Lafayette, Louisiana. Before Smith reached the bank to make the night deposit, she was robbed by a person who crashed his truck into the rear end of Smith’s car and shot at her two times. He then smashed her window and took the deposit bag from her.

Smith injured her knee, back, and neck in the incident. Circle K paid Smith workers’ compensation benefits following the incident. However, the parties disagreed about treatment for Smith’s injured knee. Smith filed a Form 1008 under La. R.S. 23:1034.2(F)(1) against Circle K, claiming it had failed to pre-authorize her evaluation for her knee injury with her selected physician.

Worker Entitled To Unpaid Compensation Owed Him Under Contract

Published on: October 26, 2023 | By Berniard Law Firm

business_signature_contract_962355-scaled One frequent use of contracts is to establish how much someone will be paid for specified work. Clear contractual language can help prevent disputes down the road. What happens if you do not receive all the compensation to which you are entitled under your contract?

Clifton Franklin and Fountain Group Adjusters signed a contract where Franklin would provide Fountain with insurance adjusting services related to claims from Superstorm Sandy. The contract outlined how Franklin would be compensated by Fountain. Franklin claimed Fountain wanted him to sign a second contract because it could not find the first contract. While the second contract set Franklin’s compensation at 75% rather than the 65% in the initial contract, Franklin only asserted claims for the original 65% commission.

Claims One employed Franklin during this time. Fountain also signed a contract with Claims One. Although Franklin received some compensation from Fountain, he filed a lawsuit against Fountain, claiming he had not been fully compensation.

Injured Worker Who Hid Injuries Still Entitled To Workers’ Compensation

Published on: October 25, 2023 | By Berniard Law Firm

emergency_rescue_stretcher_injured-scaled If you are injured on the job, it is best practice to inform your employer and supervisor about your injuries. They will likely inform you about possible workers’ compensation to which you might be entitled. Are you still eligible to receive workers’ compensation benefits if you tried to hide your injury from your employer?

Gary Jeansonne worked as a maintenance worker at a youth center located in Bunkie, Louisiana. Over two months after Jeansonne stopped working at the center, he filed a claim for workers’ compensation, claiming he had hurt his back while working at the center. He claimed the accident had occurred while he was working in the kitchen. Jeansonne claimed to have called his supervisor the next morning to tell him he would not be able to come in to work due to his back, but he did not tell his supervisor his back issues were from an injury at work.

Jeansonne started receiving medical treatment for his back injuries. His medical records indicate he told his doctor the accident that hurt his back occurred at home. Jeansonne subsequently claimed the report was not accurate and he had just said the incident occurred at home because he wanted to be able to go back to work.

Prior Mistake Does Not Waive Insurer’s Defense In Subsequent Claim

Published on: October 24, 2023 | By Berniard Law Firm

supreme_court_building_washington_3_9-scaled If you are in a car accident and your insurance pays your claim, you likely expect the same thing will happen if you are subsequently in a similar accident. What happens if your insurer paid your prior claim, but tries to deny a subsequent claim?

Brandon Forvendel was injured in a car accident. When the accident occurred, he was driving a car he owned and was insured by State Farm. Forvendel had uninsured motorist coverage. After the accident, Forvendel recovered under his uninsured motorist policy.

When the accident occurred, he was living with his mother, who also had insurance through State Farm. Forvendel also tried to recover under his mother’s uninsured motorist policy, which had higher policy limits. State Farm denied his attempt to recover under both his and his mother’s policies under the anti-stacking provisions in La. R.S. 22:1295(1)(c). Forvendel then filed a lawsuit against State Farm.

Who Is Covered By A Settlement Agreement Release?

Published on: October 23, 2023 | By Berniard Law Firm

writing_write_person_paperwork-scaled A settlement agreement can be an efficient way of resolving a claim and receiving compensation without a lengthy trial process. However, it is essential to understand what a settlement agreement does and does not cover to avoid surprises down the road if you later try to bring related lawsuits against other parties.

Kerry Maggio was injured in a car accident when he was hit by a vehicle driven by James Parker, who worked for Sandwich Kings. Brenda Parker owned the vehicle, which was insured by the Louisiana Farm Bureau. Maggio filed a lawsuit against James Parker, Sandwich Kings, and their insurers.

Maggio signed a settlement agreement and release of all claims with Brenda Parker and the Louisiana Farm Bureau. Neither James Parker nor Sandwich Kings was specifically mentioned in the release. Sandwich Kings and its insurer filed a summary judgment motion, arguing Maggio’s release applied to them because it released “all other persons” who were or might be liable for his injuries from the accident.

Hospital Not Liable For Negligent Transportation During Hurricane Katrina

Published on: October 22, 2023 | By Berniard Law Firm

hurricane_bob_1991_cyclone-scaled Over a decade after Hurricane Katrina, we have almost all heard of the difficult choices hospitals faced while trying to care for patients. This case involves a patient who was allegedly injured while being evacuated from a New Orleans hospital during Hurricane Katrina.

Lionel Favret was admitted to the hospital in New Orleans, Louisiana where he was diagnosed with a bone disease and back pain. He was treated with antibiotics and underwent back surgery. He faced a difficult recover and while in the ICU, Favret had to be resuscitated on two different occasions.

He was moved out of the ICU into a unit for surgery patients when Hurricane Katrina hit. Hospital employees carried Favret down several stories of stairs into the parking garage where he was eventually evacuated after over a day. When he arrived at the new hospital, he was diagnosed with fractures in his back and an infection. He underwent another back surgery.

Injured Work Release Inmate’s Sole Remedy Is Workers’ Compensation

Published on: October 21, 2023 | By Berniard Law Firm

prison_alcatraz_prison_wing-scaled Even while an inmate, you are still entitled to damages if you are injured on the job. If you are injured while working in a release program, are you entitled to compensation through the workers’ compensation scheme?

Lindsey French was serving a sentence for drug and firearm charges at the detention center in Claiborne Parish, Louisiana. Inmates at the detention center could be released to work for the police as part of the highway maintenance crew. French volunteered to join the crew. While on the crew, French was responsible for operating a tractor.

One day, the tractor French was using hit a tree stump. French was not wearing his seat belt. He fell through an opening in the tractor and fractured his pelvis.

Presumption of Negligence in Rear-End Accidents Does Not Always Lead To Summary Judgment Victory

Published on: October 20, 2023 | By Berniard Law Firm

car_racing_crash_accident-scaled Under Louisiana law, there is a presumption the driver of a car that rear-ends another car acted negligently. However, this presumption of negligence can be overcome in certain situations, such as if the driver of the vehicle that was rear-end shifted lanes soon before the accident.

While Tammy Bloxham was stopped at a red light in her car, she was hit from behind by Andy Gibbs Jr. At the time of the accident, Gibbs was driving a tractor-trailer owned by 31 Energy. Bloxham filed a lawsuit against Gibs, 31 Energy, and 31 Energy’s insurer. Bloxham argued 31 Energy had been negligent in hiring Gibbs and not inspecting its vehicle’s brakes. The defendants filed a summary judgment motion, claiming Bloxham had not reported this claim in her pending bankruptcy. Bloxham also filed a summary judgment motion, claiming Gibbs was liable under La. R.S. 32:81 A and the presumed negligence of the driver of a following vehicle who hits the rear of another vehicle.

The trial court granted Bloxham’s summary judgment motion given the presumption that a following driver who rear ends another vehicle is negligent. The court held this applied even if Bloxham had changed lanes immediately before the accident. The defendants filed an appeal.

Can an Independent Contractor collect Workers’ Compensation Benefits?

Published on: October 19, 2023 | By Berniard Law Firm

labor_farmer_village_work The distinction between independent contractors and employees has always been something of a balancing test. This distinction becomes vital in workers’ compensation issues, where employees generally enjoy peace of mind with workers’ compensation in the event of an injury, whereas independent contractors usually do not. But are there some cases where an independent contractor can collect workers’ compensation benefits? The answer to this question is illustrated in the following appeal from the New Orleans Office of Workers’ Compensation.

Federico Espinoza Martinez and four others were hired by Jaroslov Rames to lower a washer/dryer combination unit to the first floor of an apartment building. During the lowering of the unit, Mr. Martinez received a laceration on his hand when one of the ropes used snapped. Despite a broken rope and cut hand, Mr. Martinez and the others completed the job. Afterward, Mr. Rames drove Mr. Martinez to the emergency room, paying five hundred dollars to ensure proper treatment was administered. Mr. Martinez later attempted to collect his pay from Mr. Rames. Mr. Rames informed him that he had deducted the five-hundred-dollar emergency room fee from Mr. Martinez’s check and planned to deduct the remainder of the hospital fee from his future earnings.

Mr. Martinez filed a claim for workers’ compensation benefits he believed Mr. Rames owed him. The issue was heard by the Office of Workers’ Compensation (henceforth “OWC”), and it was found that Mr. Martinez was not an employe of Mr. Rames, but rather an independent contractor. Benefits were denied based on this finding. Mr. Martinez appealed, maintaining that the OWC failed to apply the manual labor exception outlined in La. R.S. 23:1021(7). The OWC found the manual labor exception did not apply to the set of facts, denying benefits again for Mr. Martinez.

Smoking Or Radioactive Material? Summary Judgment Reversed Given Factual Disputes On Causation

Published on: October 4, 2023 | By Berniard Law Firm

nuclear_power_plant_landscape-scaled Everyone knows someone who has been affected by cancer. Despite being a widespread disease, there is a lot we still do not know about cancer. One area where a lot is still unknown is causation. For example, lung cancer can be caused by a variety of things, including smoking and exposure to radioactive materials. These multiple potential causes can present challenging issues in lawsuits where an individual developed cancer. An medical expert is one possible way to address potential causation issues.

Riley Hickman filed lawsuits against multiple oil and gas companies, claiming he had developed lung cancer from exposure to naturally occurring radioactive material while working to clean oilfield pipes. He claimed naturally occurring radioactive material deposits inside oil pipes and have to be cleaned out, which releases radioactive dust. One of the companies Hickman sued, Shell Oil, filed a summary judgment motion. Shell claimed Hickman could not establish his exposure to naturally occurring radioactive material had caused his lung cancer, in part because Hickman had smoked his entire life. Shell argued Hickman had gotten lung cancer from smoking, not from exposure to naturally occurring radioactive material.

The trial court granted Shell’s summary judgment motion and dismissed Hickman’s claims against Shell. Shell also claimed to have filed a motion to exclude testimony from Hickman’s expert witness, but there was no record of the motion and the court never ruled on it.