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Workers' Compensation

April 2021 Legal Updates

Proof of disability necessary to support entitlement to indemnity

Moya v. Lucas, 20-329 (La. App. 5 Cir. 3/24/21), 2021 WL 1114293

Mr. Moya filed Disputed Claim for Compensation asserting that he was entitled to compensation benefits due to a work-related injury in January 2018, from which he claimed to have suffered fractures of his spine resulting in two surgeries and other medical treatment. Mr. Moya had fallen from the roof of a private home, while he claimed to be working for Mr. Lucas.

Mr. Lucas denied that Mr. Moya was an employee. Mr. Lucas claimed that he only retained Moya, when a job was too big for Mr. Lucas to handle, or if he was too busy. Mr. Lucas testified that he did not maintain workers’ compensation insurance, because he was just a regular handyman and that Moya just helped him and was not an actual employee.

Finding that Mr. Moya was an employee of Mr. Lucas, the trial court then addressed whether Mr. Moya was entitled to any benefits. The trial court found that Mr. Moya was entitled to medical treatment, but he was unable to satisfy his burden of proof that he was disabled, and the claim for indemnity benefits was denied.

The appellate court agreed, finding that the medical records showed that Mr. Moya had sustained serious injuries and had undergone two surgeries, but that alone did not establish that Mr. Moya had a disabling condition that prevented him from engaging in employment after the accident. There was an office note after discharge from the hospital showing that Mr. Moya was doing well and walking with the help of a cane. Mr. Moya had also testified that he had been able to perform some work since the accident, but that he was not able to do “heavy jobs.” None of the medical records submitted showed that Mr. Moya had any pending work restrictions. The courts noted that there was no presumption of disability when determining if the claimant is entitled to Temporary Total Disability benefits, and that the court must rely upon medical evidence to support that the employee is medically unable to engage in any employment. In regard to the alternative claim that he was entitled to Supplemental Earnings Benefits, the courts noted that Mr. Moya did not carry his initial burden of proof that he was suffering any impairment of his work ability; thus, there was no further examination necessary to determine whether SEB’s were owed. The purpose of Supplemental Earnings Benefits is to compensate the injured employee for the wage-earning capacity he lost as a result of the accident. An employee’s testimony that he can no longer return to his pre-injury employment, without more, is insufficient to prove entitlement to SEB’s.

Allen & Gooch is providing this legal update for informational purposes only. This article should not be construed as legal advice or a legal opinion as to any specific facts or circumstances. You should consult your own attorney concerning your particular situation and any specific legal questions you may have.