La. Stat. Ann. § 23:1201

Section 23:1201(E) permits statutory penalties when an employer's withholding or termination of workers' compensation benefits is arbitrary, capricious, or without probable cause.

Sinegal v. Able Glass Co., Inc. · filed 1995-10-11(E)

It is well settled that a workers' compensation claimant is not entitled to attorney's fees and penalties unless the withholding or terminating of benefits is found to be arbitrary, capricious or without probable cause.

Section 23:1201(F) authorizes penalties and attorney fees for an arbitrary or baseless termination of benefits, unless the claim is reasonably controverted.

Gordon v. Sandersons Farms · filed 1997-05-09(F), (F)(2)

An employer or insurer who terminates compensation benefits in an arbitrary and capricious manner, or without probable cause, is subject to penalties and attorney fees.

Section 23:1201 requires arbitrary or capricious nonpayment within the employer’s control before penalties and attorney fees may be awarded.

Jones v. El Mesero Restaurant · filed 1997-10-29(F)

Entitlement to statutory penalties and attorney's fees requires the employer's action be deemed arbitrary and capricious and the nonpayment of medical expenses was a result of conditions over which the employer had control. La.R.S. 23:1201; Anderson, 95-646; 664 So.2d 588.

Section 23:1201 authorizes penalties and attorney fees when an insurer arbitrarily and capriciously fails to pay compensation claims.

Lemoine v. Harris Management Co. · filed 1997-10-22(F)

Thus, an employer who submits an inaccurate job description, having omitted an integrally important activity, to a doctor for approval and then terminates benefits based on that doctor’s opinion that the employee is capable of performing the offered position has acted, at the very least, arbitrarily and capriciously.

Section 23:1201(E) permits the OWC to impose a twelve-percent penalty for unpaid workers' compensation benefits unless the employer or insurer reasonably controverts the claimant's entitlement, and the court applied that rule to deny the penalty here.

Garner v. Sheats & Frazier · filed 1995-07-05(E)

La.R.S. 23:1201(E) allows the OWC to assess a twelve percent penalty for nonpayment of worker's compensation benefits unless the employer or the insurer "reasonably controvert" the claimant's right to worker's compensation benefits. ... In the case sub judice, we do not find that Garner proved entitlement to these awards. The record shows that Dr. Foret allowed Garner to return to work without restrictions to see how his knee would perform on the job; if he was unable to perform without knee pain, Dr. Foret opined that he would have to orthoscopically examine Garner's knee. Although Garner testified that pain kept him from working steadily at his various places of employment, the record is void of any evidence that Garner communicated his complaints of continued knee pain to Dr. Foret or Sheats & Frazier. Likewise, at no time did Garner make demand upon Sheats & Frazier or its insurer to authorize payment of the additional testing suggested by Dr. Foret. Accordingly, we find no error in the hearing officer's denial of Garner's request for penalties and attorney's fees.

Former § 23:1201(E) permits penalties when an insurer unreasonably withholds or underpays workers’ compensation benefits after failing to make reasonable efforts to verify the claimant’s entitlement.

Dupree v. Ace Home & Auto · filed 1996-12-26(E)

We find that penalties and attorney fees are warranted in this case, when we consider that the adjuster knew Dr. Miller’s final report was not based upon an examination of the claimant. ... We find that LWCC acted with such indifference when it reduced Dupree’s benefits as a “straight commission” employee in November of 1993. A simple examination of her payroll records should have revealed that she was paid both hourly wages and commissions. See Daigle v. Sherwin-Williams Co., 545 So.2d 1005 (La.1989). The insurer is accountable for its failure to gather this information. We, therefore, award penalties on the difference between benefits paid and owed and an additional attorney fee of $500.00 for prosecution of this claim.

Section 23:1201(F) does not support penalties when the employer or insurer reasonably controverted the employee’s right to benefits.

Landry v. City of New Iberia · filed 1997-02-05(F)

In order to avoid an award of penalties, the employer must demonstrate that the insurer has reasonably controverted the right to benefits. La.R.S. 23:1201F(1).

Section 23:1201(E) permits recovery only when the facts negate probable cause for nonpayment; the penalty is unavailable when the employer reasonably controverted the claim.

Cleveland v. Delhi Guest Home · filed 1997-05-07(E)

Because these provisions are penal in nature they must be strictly construed, allowing recovery only in cases where the facts negate probable cause for nonpayment.

Section 23:1201(E) permits penalties for untimely benefit payments unless the employer reasonably controverts the employee's entitlement.

McGaughey v. City of New Orleans · filed 1997-05-28(E)

During the pendency of claimant's claim La. R.S. 23:1201(E) provided for penalties when benefits were not timely paid, unless the entitlement to benefits was "reasonably controverted" by the employer. ... These sections of the statute are penal in nature and must be strictly construed. ... An employer should not be penalized for taking close factual or legal questions to court for resolution. ... For these reasons, we find the Hearing Officer clearly erred in finding the City was arbitrary and capricious in failing to pay for claimant's psychiatric treatment.

Section 23:1201 permits penalties and attorney's fees for untimely medical benefits unless the claim is reasonably controverted or nonpayment results from conditions beyond the employer's or insurer's control.

Anthony v. BE & K CONST. · filed 2000-05-10(F)

The failure to timely approve medical treatment is governed by La. R.S. 23:1201. Gay v. Georgia Pacific Corporation, 32,653 (La.App.2d Cir.12/22/99), 754 So.2d 1101; Nowlin, supra. As explained by the Williams court, Section 23:1201 authorizes an award of penalties and attorney's fees if medical benefits are not paid timely, unless "the claim is reasonably controverted" or the nonpayment results from conditions over which the employer and insurer have no control. La. R.S. 23:1201. Williams, supra.

Section 23:1201(E) permits statutory penalties for unpaid medical expenses only when the nonpayment was within the employer's control and the employee made a demand for payment or treatment.

Anderson v. Biedenharn Bottling Group · filed 1995-11-02(E)

In order to recover statutory penalties under La.R.S. 23:1201(E), the nonpayment of medical expenses must not result from conditions over which the employer has no control. In order to recover under La.R.S. 23:1121(C), the withholding of consent must be arbitrary and capricious. Therefore, a requisite for recovery under these statutes is a demand made upon the employer.

Section 23:1201 imposes statutory penalties when an employer or insurer withholds compensation or medical benefits without evidence reasonably controverting the employee's right to them.

Miller v. Byles Welding & Tractor Co. · filed 1996-06-05

The employer or insurer is liable for statutory penalties for withholding benefits without evidence to `reasonably controvert' the employees [sic] right to compensation and medical benefits. La.R.S. 23:1201.

Section 23:1201(F)(2) imposes penalties when an employer or insurer withholds benefits without evidence reasonably controverting the employee’s right to compensation and medical benefits.

Boudreaux v. Production Management, Inc. · filed 1996-10-01(F)(2)

Pursuant to La.R.S. 23:1201(F)(2), an employer or insurer is liable for penalties for withholding benefits without evidence to “reasonably controvert” the employee’s right to compensation and medical benefits.

Section 23:1201(E) imposes penalties when an employer withholds compensation or medical benefits without evidence reasonably controverting the employee’s right to them.

Starnes v. Asplundh Tree Expert Co. · filed 1995-10-06(E)

The employer or insurer is liable for statutory penalties for withholding benefits without evidence to "reasonably controvert" the employee's right to compensation and medical benefits. La.R.S. 23:1201(E). ... Thus, Asplundh acted upon a good faith belief that it had valid defenses to Starnes' compensation claim. ... Considering the record before us, we find no manifest error in this determination.

Section 23:1201(F)(2) bars penalties when nonpayment is reasonably controverted; the 1995 amendments permit separate penalties for compensation and medical benefits, while (F)(4) limits a prevailing health-care provider to one penalty or attorney fee.

McLaughlin v. Hill City Oil Co./Jubilee Exxon · filed 1997-10-08(F)(2), (E), (F)(4)

An employee's right to benefits is deemed reasonably controverted if the employer or insurer had a reasonable basis for believing that medical expenses and compensation benefits were not owed to the employee. ... We have no difficulty in concluding that the 1995 amendments to La.R.S. 23:1201 also allow for multiple penalties. ... The 1995 amendments continue the distinction between compensation and medical benefits and further state that the $2,000.00 maximum applies to each "claim." Furthermore, the amendments provide that in the event a health care provider prevails in its claim for reimbursement, penalties, and attorney fees, it is limited to only one penalty or attorney fee. La.R.S. 23:1201(F)(4). This limiting language of La.R.S. 23:1201(F)(4) clearly sets forth the legislative intent that in other circumstances more than one penalty is recoverable.

Section 23:1201(E) imposes statutory penalties for unpaid compensation or medical benefits unless the employer or insurer reasonably controverts the employee's right to those benefits.

Woods v. Ryan Chevrolet, Inc. · filed 1998-04-02(E)

La. R.S. 23:1201(E) subjects the employer or insurer to statutory penalties for any unpaid compensation or medical benefits, unless the employer or insurer reasonably controverts the employee's right to those benefits. "The employee's right to such benefits will be deemed `reasonably controverted' if the employer or insurer had a reasonable basis for believing that medical expenses and indemnity benefits were not due the employee." Danzey v. Evergreen Presbyterian Ministries, 95-167, (La.App. 3 Cir. 6/7/95), 657 So.2d 491; 657 So.2d at 497-98. ... Although the hearing officer found that the February 20, 1995 release was based upon Woods' recovery from hernia surgery and not the disabling injuries to his back, shoulder and ankle, we cannot conclude that Ryan Chevrolet's refusal to make compensation payments, based upon their initial reliance on Dr. Rizzo's report and later on Dr. Nawas' report, was capricious or arbitrary. Nor do we conclude that such action subjected the employer to statutory penalties or attorney fees. Therefore, we reverse the portion of the hearing officer's judgment awarding Woods penalties and attorney's fees.

Section 23:1201 permits penalties only when there is no reasonable controversy over the claim; the opinion discusses attorney fees alongside the penalties under related law.

Bryan v. Allstate Timber Co. · filed 1998-12-16

The supreme court has held that penalties and attorney fees pursuant to La.R.S. 23:1201 and La.R.S. 23:1201.2 are applicable only in the absence of a reasonable controversy. Williams v. Regional Transit Authority, 546 So.2d 150 (La.1989). After reviewing the evidence and testimony in the present matter, particularly considering the claimant's exaggerations as to how his injury occurred, we conclude that the trial court was not clearly wrong in finding that the defendant's acts did not warrant an assessment of attorney fees and penalties.

The penalty provisions require strict construction against imposing penalties, and penalties and attorney's fees are not warranted for a simple processing error that does not show arbitrary or capricious conduct.

Albe v. Albe · filed 1997-11-19(F)(1), (F)(2)

The jurisprudence uniformly dictates that these penalty provisions are penal in nature and should be strictly construed. ... We have reviewed the record and transcript and find no evidence that LWCC acted in an arbitrary or capricious manner in its handling of this claim. The admitted error that triggered LWCC's request for an additional claim form as a matter of law does not rise to the level of indifference the statutory penalty is designed to remedy.

The court held that the 1995 amendments changing the statute’s penalty rates applied prospectively: the pre-amendment flat 12% penalty governed the initial failure to pay, while the post-judgment penalty under subsection (G) could use the amended 24% daily rate for conduct after the amendment.

Dillard's Dept. Store v. Cochennic · filed 1998-07-28(F), (G)

As to the applicable 12% penalty clause, the law is settled that-substantive laws cannot be given retroactive effect without implicating the due process and contract clauses of the United States and Louisiana Constitutions, Burmaster v. Gravity Drainage Dist. No. 2, 366 So.2d 1381 (La.1978). In the present matter, the change from a penalty of a flat 12% to one of 12% per day is clearly a substantive one, and the amendment thus can only be given prospective application. We therefore affirm the judgment as to this issue. ... Contained in this argument is also the proposition that the post-judgment penalty, if owing, |5should be calculated at the 1995 amendment rate of 24% daily, as per La. R.S. 23:1201(G). This would be so because unlike the 12% penalty, which related to the employer’s pre-1995 actions in failing to pay the claim initially, the post-judgment penalty here would be owing for actions taken after the amendment took effect, see Manuel v. La. Sheriff's Risk Management Fund, 95-0406 (La.11/27/95), 664 So.2d 81.

Section 23:1201(F) does not require penalties when the employer has a reasonable basis to contest payment of benefits.

Dean v. K-Mart Corp. · filed 1998-07-29(F)

The Hearing Officer awarded statutory penalties under La.R.S. 23:1201(F) on the ground that the claim for death benefits was not "reasonably controverted" by K-Mart. ... The effect of either standard is that the employer may not be required to pay penalties or attorney's fees if it had a "reasonable basis" to object to the payment of benefits. ... In the present case, it simply cannot be said that K-Mart was without any reasonable basis for contesting the claim for benefits. ... Thus, this is not an appropriate case for an award of penalties or attorney's fees.

Section 23:1201(E) does not require a formal written demand; written medical reports, receipts, or other evidence can satisfy its notice requirement for medical benefits and travel expenses.

McNeal v. Massman Construction Co. · filed 1999-05-05(E)

We agree with McNeal that the written notice requirement set forth in La.R.S. 23:1201(E) does not obligate an employee to submit a formal written demand. Black’s Law Dictionary (6th ed.1990) provides that “[n]otiee in its legal sense is information concerning a fact, actually communicated to a person by an authorized person, or actually derived by him from a proper source.... ” Thus, an employee is not required to submit a formal written demand in order to satisfy La.R.S. 23:1201(E). The written notice requirement could be satisfied where an employee submits medical reports, receipts, or other written evidence indicating that |9he went to the doctor, along with receipts documenting his travel expenses, or some evidence showing the distance traveled to the physician’s office.

Section 23:1201(G) imposes a mandatory limit on the penalty award, requiring the court to amend the award so it complies with that limit.

Wyble v. TUNICA BILOXI GAMING ECONOMIC DEV. · filed 2000-11-02(G)

We amend the amount of the penalty award to $3,000.00, however, to comply with the mandatory language in La.R.S. 23:1201(G).

Section 23:1201(F) allows one penalty, calculated as either twelve percent of unpaid compensation or fifty dollars per day capped at $2,000, for a claim involving unpaid compensation, while allowing a separate penalty for unpaid medical benefits.

Fontenot v. Reddell Vidrine Water Dist. · filed 2001-05-11(F)

We, therefore, find that only one penalty of either twelve percent of any unpaid compensation or fifty dollars per calendar day, not to exceed a maximum of $2,000.00, whichever is greater, applies to LWCC's miscalculation of benefits and to its improper reduction of benefits.

Section 23:1201(F) permits separate penalties for separate specific benefit demands or violations, but related failures concerning the same medical bills may constitute one violation.

Haynes v. Williams Fence and Aluminum · filed 2001-07-25(F)

The panel in the instant case agrees with the second circuit in Harvey and adopts the dissenting opinion in Fontenot. Therefore, we amend the judgment to award a $2,000.00 penalty for LUBA's incorrect calculation of temporary total disability benefits and a $2,000.00 penalty for LUBA's failure to timely pay supplemental earnings benefits in July of 1999 for a total of $4,000.00 in penalties in connection with the indemnity benefits. ... We reject Haynes's contention that separate penalties should have been awarded for each of the medical bills incurred at Cabrini Hospital on the date of the accident and for the February 1, 2000 visit to Dr. Genoff and the related travel expenses. LUBA's actions regarding the Cabrini bills are essentially a single violation, and its failure to pay the bill for the visit to Dr. Genoff and the related travel expenses is essentially a single violation.

Section 23:1201(F) permits separate penalties for separate violations involving indemnity and medical benefits claims.

Fontenot v. Reddell Vidrine Water Dist. · filed 2002-01-09(F)

After considering our conflicting rulings, we choose to adhere to our ruling in Haynes, allowing for multiple penalties for multiple violations regarding indemnity and medical benefits claims. Thus, we reverse the ruling of the original five-judge panel on this issue and now affirm the workers' compensation judge's award of a $2,000.00 penalty for the miscalculation of the initial temporary total disability rate and a $2,000.00 penalty for the improper reduction of the temporary total disability benefits to supplemental earnings benefits.

Section 23:1201(G) does not authorize additional penalties and attorney fees after the underlying judgment and the initial penalties and fees have been paid, even if they were paid late.

Fallen v. New Orleans Police Dept. · filed 2002-02-06(G)

LSA-R.S. 23:1201(G) clearly states that any additional penalties and additional attorney's fees "shall be paid at the same time as .... such award...." In the instant case, the award and the initial LSA-23:1201(G) penalties and attorney's fees were paid on March 28, 2000. Although these amounts were paid late, the plaintiff did not file his LSA-R.S. 23:1201(G) rule that is the subject of this appeal until after the amounts were paid. There is nothing in the statute that provides for an award of additional penalties and additional attorney's fees after a judgment has been satisfied.

Subsection (I)'s $8,000 penalty for arbitrary discontinuation of payments does not cap separate penalties under subsection (F) for failing to consent to an employee's selection of a treating physician; a subsection (F) violation may carry a penalty of up to $2,000.

Aisola v. Beacon Hospital Management, Inc. · filed 2014-04-02(F), (I)

We do not read La. R.S. 23:1201(1) to establish an $8,000.00 cap on all penalties awarded under Section 1201. La. R.S. 23:1201(1), for example, imposes penalties for arbitrary discontinuation of payments, whereas La. R.S. 23:1201(F) imposes penalties for the failure to consent to the selection of a treating physician. The specific wording of both provisions strongly suggests that one provision does not limit or control the other.