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Downs v. Chateau Living Center & Injured Workers Pharmacy LLC

Court of Appeal of Louisiana, Fifth Circuit

January 28, 2015

TENSHENIA DOWNS
v.
CHATEAU LIVING CENTER AND INJURED WORKERS PHARMACY, LLC

ON APPEAL FROM THE OFFICE OF WORKERS' COMPENSATION, DISTRICT 7, STATE OF LOUISIANA. NO. 13-6098. HONORABLE SYLVIA T. DUNN, JUDGE PRESIDING.

Page 876

BYRON M. FORREST, ATTORNEY AT LAW, New Orleans, Louisiana, COUNSEL FOR PLAINTIFF/APPELLEE.

CHARLES A. SCHUTTE, JR., ATTORNEY AT LAW, Baton Rouge, Louisiana, COUNSEL FOR DEFENDANT/APPELLANT.

Panel composed of Judges Marc E. Johnson, Robert M. Murphy, and Stephen J. Windhorst.

OPINION

ROBERT M. MURPHY, Judge.

Page 877

[14-672 La.App. 5 Cir. 2] Defendant-appellant, Chateau Living Center of Kenner, L.L.C. (" Chateau" ), appeals the June 2, 2014 judgment rendered bye the Office of Workers' Compensation, District 7, in favor of claimant-appellee Tenshenia Downs (" Downs" ) and appellee Injured Worker's Pharmacy, LLC (" IWP" ), ordering Chateau to reimburse IWP for the cost of prescription medications dispensed to Downs, and assessing penalties and attorney's fees against Chateau. For the reasons that follow, we reverse the June 2, 2014 judgment of the WCJ and render a judgment as provided herein.

FACTUAL BACKGROUND

This appeal arises out of a disputed claim for compensation filed by Downs on August 21, 2013 against her employer, Chateau, for payment of prescription medications issued to her by IWP. Downs sustained an injury to her back within the course and scope of her employment with Chateau on September 20, 2011, when she lifted a patient out of a bed and into a wheelchair. Downs made a claim for workers' compensation benefits arising out of the incident, which Chateau [14-672 La.App. 5 Cir. 3] accepted as compensable. As a result, Chateau began paying Downs indemnity and medical benefits, including payment of prescription medications.

Chateau's third party administrator, Employers Risk Management Services (" ERMS" ), was responsible for Downs' claim and assigned Shelia Dorsey as her claims representative. On October 13, 2011, ERMS selected and approved Carlisle Medical, Inc. (" Carlisle" ), a prescription management company, to provide Downs with the prescription medications prescribed by her treating physician. Accordingly, on December 12, 2011, ERMS sent Downs a letter informing her that Carlisle would be assisting her with her prescription medication needs, and that she would be receiving a Carlisle prescription card to use in obtaining her prescriptions. ERMS further noted that Carlisle was the only approved provider of pharmacy services for her claim.

For several months, Downs used her Carlisle card to fill prescription medications from retail pharmacies, which were paid for by Chateau through ERMS on January 12, 2012, April 4, 2012, May 2, 2012 and July 18, 2012. However, after treating with Dr. Paul Hubbell on July 31, 2012, Downs discontinued using her Carlisle card to obtain her prescriptions, and instead, began obtaining her prescriptions

Page 878

in August of 2012 via mail order through IWP.

On August 6, 2012, Dorsey received an email from Chateau advising her that IWP had requested information regarding Downs' prescription medications. On that same day, Dorsey was informed by IWP that it had already provided prescription medications to Downs. Dorsey then advised IWP that it was not authorized to provide prescription medications to Downs. On August 15, 2012, Dorsey sent IWP a letter advising IWP that its invoices for prescription medications were not approved by ERMS and that IWP was not an authorized provider of medication for Downs.

[14-672 La.App. 5 Cir. 4] Despite this information, the record shows that IWP continued to fill prescription medications for Downs from August of 2012 to March of 2014. In each instance, IWP sent Dorsey pre-authorization requests for prescription medications that had already been issued to Downs at least one day before the date of its request for pre-authorization. Dorsey sent IWP several letters advising it that it was not authorized to provide prescription medications to Downs, that Carlisle was the approved provider for Downs' claim, that it had failed to obtain pre-authorization before filling prescriptions, and that no medications billed through IWP would be approved by ERMS.

After Downs filed her disputed claim for payment of the prescription medications issued by IWP on August 21, 2013, Chateau filed an answer and reconventional demand against Downs and IWP on September 23, 2013. In its reconventional demand, Chateau sought a judgment providing that it was entitled to select the provider of prescription medications to Downs, that Downs is required to obtain prescription medications from Carlisle, and that IWP is precluded from asserting a claim for payment of prescription medications provided to Downs, given that it did so without Chateau's authorization.

The matter proceeded to trial on April 9, 2014, wherein the parties stipulated to the introduction of documentary evidence, including records of IWP, ERMS, and Carlisle, as well as correspondence from Downs' counsel. In addition, counsel for Downs and IWP introduced an affidavit from Downs, and counsel for Chateau introduced the deposition transcript of Dorsey. No live witnesses testified at trial. The workers' compensation judge (" WCJ" ) took the matter under advisement and rendered a judgment in favor of Downs and IWP on June 2, 2014. Specifically, the judgment ordered Chateau to reimburse IWP for the prescription medications issued to Downs, without providing a monetary amount to be reimbursed. The [14-672 La.App. 5 Cir. 5] judgment effectively denied Chateau's reconventional demand insofar as it orders Chateau to reimburse IWP for the prescription drug expenses it incurred with respect to Downs. The judgment further held that Chateau failed to reasonably controvert Downs' claim for benefits, and accordingly assessed penalties in the amount of $5,000 and attorney's fees in the amount of $5,000 against Chateau. From that judgment, Chateau now appeals.

ASSIGNMENTS OF ERROR

On appeal, Chateau raises the following ...


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