McCarroll vs Livingston Parish Council and Louisiana Workers’ Compensation Corporation (LWCC)

McCarroll vs Livingston Parish Council and Louisiana Workers’ Compensation
Corporation (LWCC), Court of Appeals of Louisiana, 1st Circuit (2014 La. App.
LEXIS 2570)

The McCarroll case decided on October 27, 2014 highlights the importance of proper
timing of medical treatment in a case close to settlement. In this case, Mr. McCarroll
injured his cervical spine in a work related accident on December 22, 2003. A cervical
fusion was recommended and declined in July of 2008. The parties reached a settlement
agreement in early January of 2009 which included an MSA. The MSA included a
projection for the cervical spine surgery and amounted to $98,684.00. CMS reviewed
and approved the MSA on February 2, 2009. Mr. McCarroll’s attorney subsequently
negotiated an additional $5,000.00 for his settlement for non-Medicare covered expenses.

Mr. McCarroll underwent cervical spine surgery on February 16, 2009. The surgery was
not approved by LWCC due to the pending settlement. Mr. McCarroll proceeded with
the surgery based on his belief that it would be covered by Medicare. The settlement
agreement was signed by Mr. McCarroll on March 2, 2009 and approved by the Office of
Workers’ Compensation (OWC) on March 9, 2009.

Mr. McCarroll filed a Petition to Enforce Settlement with the OWC on March 10, 2011.
He sought payment of the medical expenses associated with the cervical fusion since they
had been denied by Medicare and by LWCC. The matter was tried on April 24, 2013. The
issue was whether LWCC was responsible for the medical bills pertaining to treatment
after February 10, 2009 but before March 9, 2009. The OWC determined that there was
no meeting of the minds and vacated the settlement approved by the OWC on March
9, 2009. The Court of Appeal affirmed the OWC decision. It noted that all the parties
believed that the MSA amount could be used to pay for Mr. McCarroll’s surgery. Since
Mr. McCarroll was unable to use the MSA to pay for the surgery and Medicare would not pay for the additional costs, this misunderstanding was sufficient to set aside the
settlement approval.

The difficulties faced by the parties in the McCarroll case may have been avoided by
finalizing the CMS WCMSA determination prior to Mr. McCarroll’s surgery. Had the
surgery taken place after the settlement and CMS WCMSA were finalized, it would have
been properly characterized as “future” medical treatment. This case further highlights
the need for parties to engage in comprehensive discussions about future care during
settlement negotiations.