Appealed from The Office of Workers' Compensation District 6. Parish of Tangipahoa, State of Louisiana. Case No. 12-02339. The Honorable Gwendolyn F. Thompson, Judge Presiding.
Richard D. McShan, Amite, Louisiana, Counsel for Defendant/Appellant, Carlton Williams.
Stephen W. Glusman, Baton Rouge, Louisiana, Counsel for Plaintiff/Appellee, Louisiana Commerce & Trade, Association, SIF.
BEFORE: GUIDRY, THERIOT, AND DRAKE, JJ. Guidry, J. concurs.
[2014 1680 La.App. 1 Cir. 2]
In this suit arising from a joint petition for approval of a workers' compensation settlement, the defendant/appellant, Carlton Williams, appeals the order of the Office of Workers' Compensation (OWC), Sixth District, to incorporate a Medicare set-aside into the workers' compensation settlement. For the reasons that follow, we affirm.
FACTS AND PROCEDURAL HISTORY
On May 2, 2008, Mr. Williams was injured in an accident during the course and scope of his employment with Cypress Sawmill, Inc. Mr. Williams, as a delivery driver, suffered injury when a forklift driver dropped several stacks of wooden pallets on top of him, knocking him unconscious. His alleged injuries were to the head, shoulder, and neck, a fractured left foot, right knee and lumbar, and various other injuries. Mr. Williams filed a tort claim in the 22nd Judicial District Court against the forklift driver's employer and the employer's insurer, which was settled out of court.
Subsequent to the settlement of the tort claim, Mr. Williams, Cypress Sawmill, and its self-insured fund, the Louisiana Commerce & Trade Association (LCTA), filed a joint petition for approval of a workers' compensation settlement on April 5, 2012. The settlement terms included a lump sum, payable from Mr. Williams's tort settlement, to Cypress Sawmill and LCTA for reimbursement of workers' compensation payments made to Mr. Williams. The settlement term also included a Medicare set-aside analysis to be submitted to the Center
for Medicare Services (CMS) to determine a Medicare set-aside allocation (MSA), which would be used to reimburse Medicare from the tort settlement funds for any payments Medicare made on behalf of Mr. Williams.
[2014 1680 La.App. 1 Cir. 3] The order approving the settlement and dismissing Mr. Williams's workers' compensation claim was initially denied. The petition and order were amended to include specific language about the settlement amount and the MSA analysis that was lacking in the original order. The OWC signed the amended order on April 19, 2012, dismissing Mr. Williams's claim for compensation with prejudice.
Novare, LLC prepared the MSA analysis. CMS requested additional information in order to review the set-aside amount. LCTA filed a rule to enforce judgment on December 14, 2012, claiming that Mr. Williams would not execute the " General Release of Information" medical consent form that is required by CMS to authorize the analysis. CMS rejected the analysis for lacking documentation of Mr. Williams's medical history. As a result, on February 19, 2013, the OWC ordered Mr. Williams to cooperate with LCTA to provide the authorization required to ...