The Louisiana Supreme Court recently reversed and remanded the district’s court’s decision to sustain an exception of prescription, which the Louisiana Court of Appeals for the Fourth Circuit affirmed. The claimant was employed by St. Bernard Parish Government (“St. Bernard”) as a firefighter. In March of 2004, he filed a disputed claim for compensation alleging he had injured his right knee and thumb in an accident on June 2, 2002 and that he had incurred an occupational disease. He had described his injuries in the 2004 disputed claim for compensation as a “torqued knee” and “Heart and Lung”, indirectly referencing the Fireman’s Heart and Lung Act. After the accident, the claimant began receiving maximum workers’ compensation benefits, which continued until St. Bernard terminated them on June 3, 2003. In the meantime, the claimant had taken disability retirement in January 2003. The 2004 disputed claim took issue with claimant’s wage benefits having been terminated or reduced on June 3, 2003 and that medical treatment was not being paid. The disputed claim form was filed within one year of the termination of the benefits. Throughout the 2004 litigation, the claimant consistently argued that his heart and lung conditions were related to his employment.
On August 16, 2013, St. Bernard, identifying the claimant’s benefits as Supplemental Earnings Benefits (“SEBs”), gave notice that it would terminate SEBs effective August 27, 2013, on the basis that he will have received the full 520 weeks of payments as of August 26, 2013. On November 22, 2013, the claimant filed another disputed claim for compensation citing “knees, heart and lung” as his injuries. Specific to the heart and lung, he stated “Heart and Lung—permanent disability.” He cited the particular dispute as termination of his wage benefits on August 27, 2013. He contended that because he was a fireman, his heart and lung issues were presumed to be related.
With regard to the claims under the Firefighter’s Heart and Lung Act, St. Bernard asserted through its filing of exceptions that the 2013 claim for occupational injury had prescribed pursuant to La. R.S. 23:1031.1, because the claimant admitted that: 1) he had heart and lung issued on his 2004 disputed claim for compensation, 2) on May 2, 2005, he acknowledged that he had “heart and lung conditions which were caused by his employment”, and 3) he took disability retirement in 2003. In addition, St. Bernard’s exception of res judicata asserted that the November 2013 claims were previously the subject of litigation between the same parties in 2004, and were resolved through a settlement and dismissal of the litigation in 2008.
The workers’ compensation judge sustained the exceptions of prescription with regard to the Fireman’s Heart and Lunch Statute, which was affirmed by the Court of Appeal for the Fourth Circuit of Louisiana. The Louisiana Supreme Court reversed these decisions and remanded the matter to the Office of Workers’ Compensation for further proceedings.
The Louisiana Supreme Court first held that payment of maximum disability payments following the 2004 disputed claim, which included a claim for indemnity benefits for both the knee injury and the heart and lung issues, interrupted prescription with respect to the claimant’s 2013 disputed claim for permanent disability for the same injuries filed within one year of the termination of indemnity benefits. Although the 2004 form did not assert that the claimant was totally and permanently disabled at the time, he did state that he had an occupational disease, as well as injury to the right knee. There was no indication in the record that the ongoing payments were only for the knee injury, or that the claimant had relinquished any claim for permanent total disability as a result of his heart and lung condition. There is no dispute that the claimant consistently asserted both his knee injury and his heart and lunch condition as causes of his disability. The Court concluded that the lower courts manifestly erred in finding the indemnity payments to the claimant had been made only for his knee injury and not for disability as a result of both his knee injury and his heart and lung condition. The claimant’s August 2013 disputed claim for permanent and total disability under the Heart and Lung Statute was timely filed within one year of the termination of his indemnity benefits in June of 2013.
The Louisiana Supreme Court also reversed the lower courts’ decisions with regard prescription of the claimant’s claims for medical benefits under the Heart and Lung Statute. The record showed that the 2009 payment of medical expenses was for the claimant’s knee injury, rather than his heart and lung condition. The record further showed that because there had yet been no determination by the workers’ compensation judge that the claimant was entitled to benefits under the Heart and Lung Statute, there had been no payment of medical benefits for the heart and lung condition such that the three-year prescriptive period would have commenced to run. The Court reasoned that it would be illogical to find that a claim for medical benefits under the Heart and Lung Statute would be prescribed before it has been determined that the claimant was entitled to benefits under that statute. For these reasons, the Louisiana Supreme Court held that the claimant timely filed his 2013 disputed claim asserting permanent and total disability as a result of his heart and lunch condition.
This case illustrates the courts’ and legislature’s interest in ensuring an employee will be paid compensation for the full period of his disability. In the realm of workers’ compensation, an employer cannot rely on mere technicalities of the passing of a prescriptive period to deny an employee benefits. An employer and its counsel must be attentive to the claims asserted and the benefits paid when asserting any defense, especially with regard to the denial of a claim based on prescription or res judicata.
Borja v. FARA