Public Health Emergencies, Medical Review Panels, and Gross Negligence – Where Does Louisiana Currently Stand?

A worker’s benefits may be forfeited if the employee is untruthful on a medical questionnaire (if the misrepresentations directly relate to the alleged injury) or prejudices the employer’s ability to recovery from the “Louisiana Second Injury Fund.” La. R.S. 23:1208.1 Some Louisiana courts have shown reluctance to deny workers’ compensation benefits based on the employee’s alleged failure to truthfully answer a medical history questionnaire. However, the court in Spillman v. Career Adventures, Inc., --- So.3d ---- 2021 (La. App. 2d Cir. 8/11/21), 2021 WL 3523959, held that benefits were forfeited because the claimant provided false responses to several medical history questions and failed to answer a number of specific questions on a post-hire medical history questionnaire provided by his employer.

At trial, it was established that Spillman had pre-incident medical conditions to include: 1) injuries related to a 2007 work-related accident; 2) regional sympathetic dystrophy of the left foot; 3) COPD; 4) chronic pain from a gunshot wound in his left leg; 5) surgery to the AC joint of his right shoulder; 6) injuries from a 2018 motor vehicle accident to the right shoulder and right knee; 7) anxiety; 8) bipolar disorder; and 9) many other ailments.

Like many other employers, Spillman’s employer Career Adventures included with its employment packet a “Office of Workers’ Compensation Second Injury Board Questionnaire.” Spillman failed to truthfully complete this questionnaire and checked “no” to specific questions which asked if he had experienced many of his known conditions such as COPD and bipolar disorder. Although Spillman took the time to respond to numerous “fill in the blank” questions, he purposefully skipped at least 10 inquiries.

Eleven months after hire, Spillman alleged he was injured at work while performing his duties as a welder. At trial, Spillman’s family physician identified a torn tendon in the left elbow as a work-related injury. He further testified that the tendon injury limited his activities and merged with his pre-existing injuries to create a greater total disability. The workers’ compensation judge (“WCJ”) ruled that Spillman violated La. 23:1208.1 by failing to truthfully answer certain questions. The Second Circuit “went further” in affirming the workers’ compensation judge, stating:

“We go further than the WCJ. All information which would have been disclosed had Mr. Spillman truthfully answered each and every question on the preemployment questionnaire must be considered …”

Therefore, the appellate court in Spillman found that both false answers and a failure to answer certain questions can qualify as a willful misrepresentation sufficient to cause a forfeiture of benefits under La. R.S. 23:1208.1 under certain circumstances.

The Louisiana Supreme Court recently held that a claim for defense and indemnity may be asserted before a judicial finding of liability. The Court’s decision overruled prior decisions that held claims for defense and indemnity were premature until it was determined that damages were actually owed and the party claiming indemnity sustained a loss.

In Daniel Bennett v. Demco Energy Services, the plaintiff alleged he was injured when he drove over a downed power line that belonged to Cox Communications. Evidence showed Cox Communications contracted with Cable Man to provide services, maintenance, and repair for its telecommunication companies. The contract covered maintenance and repair of the subject phone line.

The contract included an indemnification provision that required Cable Man to indemnify and defend Cox Communications from any and all claims relating to Cable Man’s work, Pursuant to the contract, Cox Communications sent Cable Man a request to tender defense and indemnification under the contract. Cable Man refused the tender and Cox Communications filed a cross-claim against Cable Man asserting that it was owed defense and indemnification. In response, Cable Man filed an Exception of Prematurity and maintained that the claim for indemnity had not accrued because there had not been a judgment or a finding a Cable Man’s fault or liability.

The Louisiana First Circuit Court of Appeals granted the Exception of Prematurity and stated that “It is well-established that claims for indemnity, as well as claims for defense arising under an indemnity agreement, are premature prior to a determination that damages are actually owed and the indemnitee sustains a loss.” The court reasoned that the lawsuit was still pending against both parties and no liability determination had been made. Therefore, under the “well-established” law, Cable Man owed no obligation to Cox Communications for indemnity and costs at the time Cox asserted its cross-claim.

However, the Louisiana Supreme Court reversed the First Circuit’s decision and Cable Man’s claims of prematurity were denied. Acknowledging such claims for indemnification previously were considered premature, the Court held the law moving forward should allow for a claim for indemnity, whether in a third-party demand or a cross-claim, that is raised during the course of litigation and before a finding of liability. Further, the Court recognized potential inconsistencies with prior judicial determinations and stated, “in light of our ruling today, to the extent any prior jurisprudence can be interpreted otherwise, we now clarify that such a claim for indemnity is not prohibited before a liability adjudication.”

This ruling makes clear that “asserting a claim for indemnity, arising out of the same facts and circumstances, is not premature before a judicial finding of liability.” The right to collect on an indemnity agreement continues to be determined upon a finding of liability or loss, but a claim for indemnity can now be asserted in the same proceeding.

References:

Daniel Bennett v. Demco Energy Services, et al, 2023-CC-01358 (La. 5/10/24); 386 So.3d 270.

Recently, the Louisiana Supreme Court issued a significant ruling in a class action case handled by Keogh Cox partners Chris Jones and Nancy Gilbert. The case involved tax credits for solar panels. The Court’s ruling overturned a lower court decision that held an Act of the Legislature unconstitutional. After the plaintiffs’ Application for Rehearing was denied, the Court’s decision is now final.

In Ulrich, et al. v. Kimberly Robinson, Secretary of the Louisiana Department of Revenue, 2018-0534 (La. 3/26/19), 2019 WL 1395316, the class action plaintiffs were persons who purchased and installed residential solar panel systems in their homes. When they claimed the solar electric system tax credits on their 2015 state tax returns pursuant to La. R.S. 47:6030, the tax credits were denied by the Louisiana Department of Revenue, based on Act 131 of the 2015 legislative session. Act 131 capped the maximum amount of solar panel tax credits to be granted by the Department of Revenue, and the plaintiffs’ claims were made after the cap was exhausted.

When their claims for the tax credits were denied, plaintiffs filed a declaratory judgment action seeking to declare Act 131 unconstitutional. During the pendency of the suit in the district court, the Louisiana Legislature enacted Act 413 which provided additional funding for solar tax credits. Under Act 131, all taxpayers whose solar panel tax credit claims were previously denied would receive the entirety of their tax credits over installments. The district court declared Act 131 unconstitutional and concluded that Act 413 did not moot the controversy.

Because the district court declared Act 131 unconstitutional, the Department directly appealed the decision to the Louisiana Supreme Court. Oral arguments occurred in October of 2018. In the Court’s recent opinion, it concluded that Act 413 mooted the controversy. According to the Court, the plaintiffs no longer maintained a “justiciable controversy” because Act 413 provided for the payment of the entirety of the previously denied tax credits. Accordingly, the Court overruled the district court’s judgment that declared Act 131 unconstitutional. Plaintiffs filed an Application for Rehearing and that request was recently denied, making this decision final.

Chris Jones is a partner with Keogh Cox in Baton Rouge, LA. He focuses his practice on class actions and mass torts, and handles these matters in courts throughout the country. He is a life-long resident of Baton Rouge, where he lives with his wife and four children.