FROM THE OFFICE OF WORKERS' COMPENSATION - DISTRICT 04
PARISH OF LAFAYETTE, NO. 18-08509 ANTHONY PALERMO,
WORKERS' COMPENSATION JUDGE.
L. Riley The Glenn Armentor Law Corporation COUNSEL FOR:
Plaintiff/Appellant - Christine Gotreaux.
M. Meaux Allen & Gooch, A Law Corporation COUNSEL FOR:
Defendants/Appellees - Liberty Mutual Insurance Company and
Quick Turn Merchandising.
composed of Ulysses Gene Thibodeaux, Chief Judge, Phyllis M.
Keaty, and Candyce G. Perret, Judges.
ULYSSES GENE THIBODEAUX CHIEF JUDGE.
Christine Gotreaux, filed an appeal to the Office of
Workers' Compensation (OWC) Medical Director after her
employer, Quick Turn Merchandising, and its insurer, Liberty
Mutual Insurance Company (collectively Defendants), denied
her orthopedic surgeon's request for approval for a
thoracic spinal fusion. The Medical Director denied the
appeal, finding no segmental instability or other criteria to
warrant its approval of Plaintiff's request. Plaintiff
then appealed the Medical Director's decision to the OWC.
Finding Plaintiff had failed to prove, by clear and
convincing evidence, that the Medical Director's decision
was not in accordance with the Workers' Compensation Act
(WCA), the Workers' Compensation Judge (WCJ) rendered
judgment in favor of Defendants, dismissing the matter with
our review of the record reveals no manifest error in the
WCJ's review of the Medical Director's finding as to
segmental instability, we nevertheless reverse its dismissal
of Plaintiff's claim as we find the WCJ legally erred in
too narrowly interpreting the lumbar fusion guidelines he
relied upon in refusing to overturn the Medical
Director's decision that Plaintiff was not entitled to a
variance under the WCA. Accordingly, we affirm the judgment
on the issue of segmental instability, reverse the judgment
as to dismissal, and remand this matter to the WCJ for
further proceedings consistent with this opinion.
shall decide whether the WCJ erred misinterpreting the
application of the Medical Treatment Schedules and thereby
denying the claim.
AND PROCEDURAL HISTORY
workers' compensation claim arises out of an accident
that occurred on April 9, 2011, when Plaintiff was employed
by Quick Turn Merchandising to provide services at a
Lowe's store in Lafayette, Louisiana. While moving a rack
of plants, Plaintiff felt her back crack. Although Defendants
initially denied the claim, the matter was litigated and
ultimately resolved by a consent judgment which stated that
Plaintiff was injured in the course and scope of her
employment, compensation was due at the rate of $262.50 per
week, and medical treatment was to be provided pursuant to
the OWC medical treatment guidelines.
the last eight years, Plaintiff has seen numerous physicians
and has had multiple surgeries, including both lumbar and
cervical spinal fusions. There have also been several
additional disputes about payments and medical treatment
since the original consent judgment.
current dispute and appeal arise from a Form 1010 request
made by Dr. Mark McDonnell, Plaintiff's orthopedic
surgeon, for authorization or approval for a thoracic spinal
fusion that was not preauthorized by the medical treatment
guidelines. Defendants denied the request for a lack of
segmental instability. A Form 1009 appeal to the Medical
Director was denied for lack of instability or other fusion
criteria. Plaintiff then filed a Form 1008 to appeal the
Medical Director's decision.
hearing was held for the parties to present arguments and
evidence regarding the merits of Plaintiff's appeal,
during which Plaintiff introduced several exhibits: (1) Dr.
McDonnell's medical records; (2) the Form 1010; (3) the
Form 1009; (4) the Medical Director's decision; (5)
excerpts from the medical treatment guidelines on lumbar
spine, La. Admin. Code tit. 40, Pt. I, § 2023(G)(4)(d);
(6) New York State medical guidelines for mid and lower back
injuries; (7) ...