Claims cannot go on forever, and the party must eventually end. Thus, Louisiana claims often have prescriptive periods, the civil law equivalent of statutes-of-limitations.
In the workers’ compensation arena, Louisiana also imposes a duty on employers to pay for necessary medical services of its injured employees while also granting the employer a right to have claimants undergo independent medical examinations. The duty to pay medical benefits is not unending, the Legislature capping the period of time for which payments are due at three years from the last payment of medical benefits. What then, when there are no medical payments made for more than three years save an employer’s payment to a doctor for performing a second medical opinion exam?
Louisiana’s First Circuit Court of Appeal answered this question in Kennedy v. Washington/St. Tammany Reg. Med. Ctr., 2015-1099 (La. App. 1st Cir. 4/7/16); 2016 WL 1394541. Claimant brought suit on January 26, 2015 seeking medical payments, penalties, and attorney fees for an on-the-job slip-and-fall injury suffered August 24, 2006. The employer’s insurer had paid medical benefits through February of 2010 when claimant reached maximum medical improvement and paid for x-rays and missed appointments in 2011. When the employer informed the court that it had not paid medical benefits for more than three years before suit was filed, claimant rejoined that the employer had paid for a second medical opinion examination on February 9, 2012. The workers’ compensation judge found that the employer had the better of the argument and sustained the employer’s prescription argument. The court of appeals agreed, finding that payment for the SMO examination was doubtfully for treatment and certainly not necessary.
Accordingly, the only medical benefits payments which can serve to interrupt prescription must be for necessary treatment. If no payments are made for three years, the claim is ended.
Kennedy v. Washington/St. Tammany Reg. Med. Ctr.8