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Caldwell Wholesale Co. v. Smith12/14/2005
Before WILLIAMS, PEATROSS and MOORE, JJ.
The defendant, Edgar Smith, appeals a judgment finding that his medical problems of stroke and ischemic colitis and his permanent and total disability are unrelated to his myocardial infarction in 1980. The trial court dismissed defendant's reconventional demand seeking payment of medical expenses, permanent total disability benefits, penalties and attorney fees. For the following reasons, we reverse in part, amend and affirm as amended.
FACTS
Edgar Smith worked for Caldwell Wholesale Company ("Caldwell") as an outside salesman with a route in Northwest Louisiana. On August 20, 1980, Smith suffered a heart attack while making a sales call at a grocery store in Shreveport. He reported to the emergency room at Schumpert Medical Center for treatment. Caldwell, through its workers' compensation insurer, The Phoenix Insurance Company ("Phoenix"), paid compensation benefits to Smith until November 24, 1980, when he returned to work.
Smith continued to experience heart problems and in April 1982 he underwent coronary bypass surgery. In August 1982, Smith returned to part-time work and in March 1983 he was released to perform his usual duties. In October 1983, Smith suffered another heart attack and the insurer resumed payment of workers' compensation benefits.
Subsequently, Smith applied for and was awarded Social Security disability benefits effective October 9, 1983, based on a finding that Smith suffered from ischemic heart disease with chest pain. In February 1986, Caldwell's insurer reduced Smith's weekly benefit from $148 to $94.24 as an offset of his Social Security disability payments.
In 1999, Smith suffered a stroke and in August 2000, he was hospitalized and treated for ischemic colitis. Caldwell's insurer refused to pay the medical expenses related to these conditions. Smith's attorney wrote a letter to the insurer concerning the unpaid charges and enclosed a note from Smith's treating physician, Dr. James Jackson, who opined that the ischemic colitis was "secondary to the same disease process" which caused Smith's underlying heart attack. In response, the insurer sought a second opinion from Dr. Thomas Brown, who opined that Smith's colitis was not caused by the job stress and heart attack 20 years earlier. The insurer denied payment for Smith's hospitalization.
Subsequently, Caldwell and its insurer, Phoenix, filed a petition for declaratory judgment asking the district court to resolve issues concerning their responsibility to continue paying Smith workers' compensation benefits. Smith filed a declinatory exception of lack of subject matter jurisdiction on the grounds that the Office of Workers' Compensation (OWC) has exclusive original jurisdiction of matters involving compensation benefits. After the exception was denied, Smith filed an answer and three amended petitions-in-reconvention seeking payment of medical expenses incurred for the treatment of ischemic colitis and stroke, permanent total disability (PTD) benefits, reimbursement for the offset in workers' compensation payments, penalties and attorney fees.
After a trial, the court issued a ruling finding that Smith's 1980 heart attack was work related and was compensable and that the employer was estopped from denying that claim. The court also found that Smith's subsequent stroke and ischemic colitis were not related to the 1980 myocardial infarction and that medical expenses for those conditions were not compensable. After taking Smith's claim for PTD benefits under advisement, the trial court issued a supplemental ruling finding that his present status of permanent and total disability was not cause
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