Louisiana Court of Appeal Reverses Dismissal of Claim for Workers’ Compensation Coverage in Falling Elevator Injury Case

If you are injured on the job, you are entitled to benefits through the workers’ compensation system. Although this process can be straightforward, when an individual suffers serious and complex injuries it can be very difficult to receive the medical treatment and reimbursement that you deserve. Our seasoned team of Louisiana work injury lawyers has seen firsthand just how critical it can be to have a dedicated legal professional on your side.

A recent appellate opinion discusses a situation in which a man suffered serious injuries in an elevator accident. The man worked for a public entity and earned weekly wages of $3,300. In 2011, he left his office on the eighth floor of the building at the end of the day and descended in the elevator. When it reached the third floor, it dropped suddenly and fell to the ground level. The impact was significant and the man suffered injuries to his knees, back, and hip.

The man underwent medical treatment, including an MRI that revealed serious injuries to these areas of his body. As a result of these injuries, he required bilateral knee surgery. Although he underwent significant treatment for his back injury, he was unable to manage the pain. He ultimately underwent surgery, but it was also unsuccessful. There were many additional medical treatments and tests that doctors performed related to the man’s injuries.

The man reported these treatments to the Office of Workers’ Compensation (OWC) and required approval for some of the surgeries. When the treating physicians recommended a second spinal surgery, the man again sought approval but the medical director at the OWC rejected coverage of the surgery. The man filed an appeal and the matter was assigned to an OWC judge. After a hearing on the issue, the judge dismissed the matter with prejudice and upheld the medical director’s decision.

The man appealed the decision, stating that the OWC judge erred by not allowing him to present new evidence to meet his burden of establishing by clear and convincing evidence that the medical director erred in refusing to approve the second surgery. The man also alleged that the medical director’s decision was not in accordance with the Medical Treatment Guidelines recognized by the State of Louisiana.

On review, the court of appeal sided with the man and determined that the reviewing judge should have allowed the man to present additional evidence regarding his need for the second surgery. The court remanded the action with instructions to the OWC judge to allow the man to present the additional evidence. According to Louisiana law, when a claimant challenges a medical director’s decision, the burden of proof that the claimant must satisfy is a heightened standard of clear and convincing evidence.

If you were injured at work, you may be entitled to compensation. Some personal injury accidents may implicate your work duties and it can be confusing to know whether to pursue legal action in a civil tort claim or a workers’ compensation claim. Our seasoned team of lawyers and legal professionals will guide you through the entire process and ensure that you understand the full scope and extent of your legal rights. To schedule your free consultation call us at 1-800-929-7481 or contact us online.

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