HYGINUS v. OCHSNER HEALTH SYSTEM CLINIC FOUNDATION (2025)

Plaintiff/Appellant, Anthony Hyginus, appeals a judgment that dismissed his workers’ compensation claim in favor of Defendant/Appellee, Ochsner Clinic Foundation, filed in the Office of Workers’ Compensation, District 7. Mr. Hyginus filed a disputed claim for compensation for medical and permanent residual benefits, to which Ochsner filed several exceptions. The exceptions were sustained, and Mr. Hyginus was allowed to amend his claim. He filed two amended disputed claims. Ochsner filed a motion to dismiss, asserting the defects in the claim were not cured. The motion to dismiss was granted. For the following reasons, we affirm the judgment as amended.

FACTS AND PROCEDURAL HISTORY

On March 20, 2024, Mr. Hyginus filed a Form 1008 disputed claim for compensation with the Office of Workers’ Compensation (hereinafter referred to as “the OWC”). In his claim, Mr. Hyginus alleged that, on December 22, 2021, he sustained injuries on an elevator at Ochsner Hospital located on Jefferson Highway, while performing duties as a Spiritual Care Supervisor. He stated that Elevator #61 malfunctioned on the seventh floor and rapidly dropped from the seventh floor to the first floor, ending with an abrupt stop. He described being violently thrown to the ground during the rapid descent and being knocked unconscious. Mr. Hyginus claimed to have been stuck in the elevator for an extended period of time.

Mr. Hyginus alleged that he sustained painful and debilitating injuries to his entire body. He indicated that he was receiving medically necessary care, and he sought continuous care. Mr. Hyginus asserted that Ochsner initiated workers’ compensation plans for him with third-party administrators, Sedgwick Claims Management Service, Inc. (hereinafter referred to as “Sedgwick”) and Broadspire; however, Ochsner had failed to authorize any medical benefits on his behalf since December 1, 2022. He also asserted no wage benefits had been paid. The claim did not identify a registered agent for Ochsner.

Ochsner filed an answer to Mr. Hyginus's claim on June 3, 2024, denying indebtedness to Mr. Hyginus for any workers’ compensation benefits.¹ Along with its answer, Ochsner filed exceptions of improper venue, lack of procedural capacity, no right of action, no cause of action, insufficiency of service and citation, prescription, prematurity, vagueness, and ambiguity. Specifically, Ochsner argued that Mr. Hyginus's alleged entitlement to any form of wage or indemnity benefits was prescribed on its face. With respect to the exception of prematurity, it argued that Mr. Hyginus's claim for medical treatment in his disputed claim was premature because he had not complied with the procedures set forth in La. R.S. 23:1020.1, et seq.—particularly, the initiation of a request for medical treatment via a Form 1010—prior to filing.

A hearing on the exceptions was held on September 5, 2024. In a judgment rendered on September 19, 2024, the OWC sustained the exceptions of no right of action and no cause of action in favor of Broadspire and Sedgwick and dismissed Mr. Hyginus's claims against them without prejudice. The OWC sustained the exception of insufficiency of service and citation and allowed Mr. Hyginus 21 days from the signing of the judgment to properly execute service upon Ochsner. It further sustained the exceptions of prescription, no cause of action, prematurity, and vagueness. Regarding those exceptions, Mr. Hyginus was allowed 14 days from the signing of the judgment to amend his disputed claim to provide more specific factual allegations regarding his entitlement to indemnity benefits and medical benefits.

Mr. Hyginus filed an amended disputed claim for compensation on October 3, 2024, asserting altered allegations. In the amended claim, he asserted that Ochsner initiated bi-weekly permanent residual benefit payments for him in the amount of $1,354.68, but those payments were terminated on November 25, 2022. He also stated that Ochsner initiated medical benefit payments; however, the last payment was made by Ochsner on January 17, 2024 for services billed on April 27, 2022. Mr. Hyginus claimed that he was entitled to permanent partial disability or permanent residual wage compensation beginning November 25, 2022 because his ability to work was permanently impaired. He also claimed entitlement to continued medical benefits commencing from the last issued billing date of December 1, 2022. The amended claim did not identify a registered agent for Ochsner.

In response, Ochsner filed a motion to dismiss on November 22, 2024. In its motion, Ochsner argued that Mr. Hyginus's purported October 3, 2024 amended claim did not properly seek service upon Ochsner; did not address any exception related to medical benefits; did not address the exceptions of no cause of action and no right of action; and did not cure the exception of prescription. Ochsner contended Mr. Hyginus failed to identify its registered agent and requested service at an address found to be improper by the OWC. It averred that the purported amended claim did not specifically identify any disputed or unauthorized medical treatment and failed to provide information regarding his or his healthcare providers’ compliance with the workers’ compensation procedures. Ochsner argued that Mr. Hyginus failed to address his attorney's July 7, 2023 letter regarding his no right of action. Concerning the exception of prescription, Ochsner maintained that Mr. Hyginus's purported disputed claim had prescribed, as the original claim was filed on March 20, 2024—more than one year after its alleged last payment was made on November 25, 2022.

Prior to the hearing on the motion to dismiss, Mr. Hyginus filed a second amended disputed claim for compensation on December 11, 2024. That filing listed C T Corporation System as Ochsner's registered agent for service. Mr. Hyginus also amended his claim to include the names of his healthcare providers and treatment dates. Furthermore, despite alleging that he was paid permanent residual wage benefits in the “Additional Information” section, the box on the form stating that no wage benefits had been paid was checked.

Also on December 11, 2024, Mr. Hyginus opposed Ochsner's motion to dismiss. He acknowledged an oversight in originally identifying Ochsner's registered agent but asserted that the procedural defect was rectified and service of process would be effectuated on Ochsner's registered agent. Mr. Hyginus argued that his attorney sent the July 7, 2023 letter under the impression that the matter was a tort action, based upon the information he had at that time. Since that time, his attorney reexamined the factual scenario and opined that it supported both a workers’ compensation case and a tort case.

In reference to the exception of prescription, Mr. Hyginus asserted that his second amended disputed claim revised the allegation to state that no disability benefits were paid at any material time. He argued that a related tort case was filed in Orleans Parish Civil District Court on December 21, 2022, but it was dismissed on December 17, 2023. Another tort case stemming from the same injury was filed in the 24th Judicial District Court on December 6, 2023; however, it was dismissed on March 25, 2024. He claimed that those tort cases tolled the prescriptive period for filing his workers’ compensation claim.

A hearing on Ochsner's motion to dismiss was held on January 15, 2025. At the hearing, the OWC judge orally found Mr. Hyginus failed to produce any evidence of the cases that he alleged interrupted prescription. The judge further found Mr. Hyginus failed to provide any evidence of indemnity payments allegedly paid by Ochsner. In a judgment dated January 16, 2025, the OWC granted Ochsner's motion and dismissed Mr. Hyginus's action in its entirety with prejudice.

Mr. Hyginus filed a motion for new trial and motion to vacate on February 4, 2025. In his motion, he argued that the availability of new and important evidence—his medical treatment history and a properly executed choice of physician form—was neither available nor obtainable prior to the hearing on the motion to dismiss. Mr. Hyginus further argued that the lack of assistance from the Office of Workers’ Compensation and/or Ochsner's insurer hindered his ability to present a complete case.

A hearing on Mr. Hyginus's motion for new trial was held on March 11, 2025. The motion was denied in a judgment rendered on March 12, 2025. The judgment again dismissed Mr. Hyginus's action with prejudice. In its reasons for judgment, the OWC found that Mr. Hyginus failed to produce the allegedly newly discovered medical records or the choice of physician form. The OWC reasoned that Mr. Hyginus was unable to prove that he could not, with due diligence, have obtained those records prior to the hearing. As such, the OWC found that Mr. Hyginus was unable to prove that he qualified for one of the peremptive grounds set forth in La. C.C.P. art. 1972(2). The instant appeal followed.

ASSIGNMENTS OF ERROR

On appeal, Mr. Hyginus alleges that the OWC committed reversible error by sustaining Ochsner's: 1) exception of prescription; 2) exception of insufficiency of service and citation; 3) exceptions of lack of procedural capacity, no right of action, and no cause of action as to Broadspire and Sedgwick Claims Management Service, Inc.; 4) exception of prematurity; 5) exception of vagueness and ambiguity; and 6) exception of no cause of action. He further alleges that the OWC committed reversible error by not affording him another opportunity to amend his petition.

LAW AND ANALYSIS

General Motion to Dismiss Law

Louisiana courts generally employ an abuse of discretion standard when reviewing lower court decisions on sanctions or dismissal. Chavez v. Metso Minerals Indus., Inc., 23-1029 (La. 10/24/24), 395 So.3d 771, 781, reh'g denied, 23-1029 (La. 12/12/24), 397 So.3d 306. See also, Jones v. Cisneros, 20-582 (La. App. 4 Cir. 4/7/21), 315 So.3d 959, 962, where the court held, “An appellate court reviews a trial court's ruling on a motion to dismiss under an abuse of discretion and manifest error standard of review.” In this matter, we are tasked with determining whether the OWC abused its discretion by dismissing Mr. Hyginus's entire workers’ compensation disputed claim.

Prescription

Mr. Hyginus alleges the OWC erroneously found his disputed claim prescribed. He claims that Ochsner's prescription argument is both legally and factually unsupported. He argues that the last payment for his authorized medical treatment was made in December of 2022; thus, he had until December of 2025 to file a claim for medical benefits for his work-related injury. Mr. Hyginus contends that his March 19, 2024 filing was well-within the prescriptive period for his workers’ compensation claim.

In opposition, Ochsner argues that the OWC properly sustained its exception of prescription because Mr. Hyginus's disputed claim was prescribed on its face. It avers that Mr. Hyginus alleged the accident occurred on December 22, 2021; yet, his initial claim was not filed until March 20, 2024—well over one year from the date of the alleged accident. Ochsner further avers that Mr. Hyginus's amended claim did not cure the prescription defect. It contends that the burden of proof shifted to Mr. Hyginus to present evidence that the one-year prescriptive period for indemnity benefits was interrupted or suspended, and Mr. Hyginus failed to do so. As a result, Ochsner maintains that the OWC properly granted its motion to dismiss.

La. R.S. 23:1209 provides the following pertinent prescriptive periods for workers’ compensation claims by stating:

A. (1) In case of personal injury, including death resulting therefrom, all claims for payments shall be forever barred unless within one year after the accident or death the parties have agreed upon the payments to be made under this Chapter, or unless within one year after the accident a formal claim has been filed as provided in Subsection B of this Section and in this Chapter.

(2) Where such payments have been made in any case, the limitation shall not take effect until the expiration of one year from the time of making the last payment, except that in cases of benefits payable pursuant to R.S. 23:1221(3) this limitation shall not take effect until three years from the time of making the last payment of benefits pursuant to R.S. 23:1221(1), (2), (3), or (4).

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C. All claims for medical benefits payable pursuant to R.S. 23:1203 shall be forever barred unless within one year after the accident or death the parties have agreed upon the payments to be made under this Chapter, or unless within one year after the accident a formal claim has been filed with the office as provided in this Chapter. Where such payments have been made in any case, this limitation shall not take effect until the expiration of three years from the time of making the last payment of medical benefits.

The function of the peremptory exception is to have the plaintiff's action declared legally nonexistent or barred by the effect of law; hence, this exception tends to dismiss or defeat the action. Ruffins v. HAZA Foods of Louisiana, LLC, 21-619 (La. App. 5 Cir. 5/25/22), 341 So.3d 1259, 1262, citing Farber v. Bobear, 10-985 (La. App. 4 Cir. 1/19/11), 56 So.3d 1061, 1069. Prescriptive statutes are strictly construed against prescription and in favor of the claim. Henry v. Southwest Airlines, 23-522 (La. App. 5 Cir. 7/31/24), 392 So.3d 1176, 1179, writ denied, 24-1081 (La. 11/20/24), 396 So.3d 68. Of the possible constructions of prescriptive statutes, the one that maintains enforcement of the claim, instead of the one that bars enforcement, should be adopted. Id.

The burden of proof in an exception of prescription lies with the party asserting it; however, where the petition shows on its face that it has prescribed, the burden shifts to the plaintiff to prove the prescriptive period has been interrupted or suspended. McClellan v. Premier Nissan, L.L.C., 14-726 (La. App. 5 Cir. 2/11/15), 167 So.3d 934, 935. At a hearing on a peremptory exception pleaded prior to trial, evidence may be introduced to support or controvert the exception. Coleman v. Ace Property & Casualty Ins. Co., 19-305 (La. App. 5 Cir. 11/27/19), 284 So.3d 1262, 1268, quoting In re Med. Review Panel of Gerard Lindquist, 18-444 (La. App. 5 Cir. 5/23/19), 274 So.3d 750. In the absence of evidence, a peremptory exception must be decided upon the facts alleged in the petition with all of the allegations accepted as true. Id. Furthermore, when no evidence is introduced at the hearing on the exception, the reviewing court simply determines whether the trial court's finding was legally correct. Id.

If evidence is introduced at the hearing on the peremptory exception of prescription, the trial court's findings of fact are reviewed under the manifest error/clearly wrong standard of review. Bailey v. Pinnacle Polymers, LLC, 24-490 (La. App. 5 Cir. 4/2/25), 412 So.3d 1063, 1076. If the findings are reasonable in light of the record reviewed in its entirety, an appellate court may not reverse, even though convinced that had it been sitting as the trier of fact, it would have weighed the evidence differently. Id.

In the case at bar, Mr. Hyginus alleged in his original disputed claim that his work-related accident occurred on December 22, 2021 and Ochsner initiated permanent residual benefit payments and medical benefit payments to him for that accident. However, he alleged that Ochsner terminated payments for those benefits in November 2022 and December 2022, respectively. Mr. Hyginus fax filed his first disputed claim for compensation on March 20, 2024. After the September 5, 2024 hearing on the various exceptions (including prescription) filed by Ochsner, the OWC found that Mr. Hyginus's disputed claim was prescribed and allowed him to file an amended disputed claim to cure the defects.²

Ochsner filed its motion to dismiss on November 22, 2024, asserting Mr. Hyginus failed to cure the defects in his first disputed claim. The January 15, 2025 hearing on the motion to dismiss was the OWC's second opportunity to consider whether Mr. Hyginus's permanent residual and medical benefit claims were prescribed.³ Four exhibits were admitted into evidence in support of maintaining Mr. Hyginus's claim at that hearing: a USPS tracking number for an item received by USPS on October 8, 2024 that had not been delivered; a USPS tracking number for an item received by USPS on December 30, 2024 that had not been delivered; an “Estimated Physician Charges” letter from LA Health Solutions dated November 27, 2024; and a copy of the amended disputed claim for compensation that was fax-filed on October 3, 2024. Ochsner offered two exhibits into evidence: the September 19, 2024 judgment and a July 7, 2023 letter from Mr. Hyginus's attorney.⁴ At the conclusion of the hearing, the OWC orally found that Mr. Hyginus failed to present any evidence that allegedly interrupted prescription. The court then granted the motion to dismiss.

In light of the record, we will now consider whether the OWC's findings were reasonable. See, Bailey, supra. Mr. Hyginus alleged that permanent residual benefit payments and medical benefit payments paid by Ochsner were respectively terminated in November 2022 and December 2022. According to La. R.S. 23:1209(A)(2), the permanent residual benefit claim would have had a one-year prescriptive period starting from the time of the last payment. Mr. Hyginus did not file his disputed claim until March 20, 2024. Consequently, his permanent residual benefit claim is prescribed on its face. To defeat prescription for that claim, Mr. Hyginus had the burden of proving that it was timely filed. A review of the record shows that he failed to present any evidence of the alleged payments for his permanent residual benefit claim by Ochsner at any of the hearings. Additionally, Mr. Hyginus argued that lawsuits filed in Orleans Parish Civil District Court and the 24th Judicial District Court tolled the prescriptive period for filing his workers’ compensation claim. Yet, he failed to present any evidence of those cases to the OWC for consideration. Mr. Hyginus failed to prove that the prescriptive period for his permanent residual benefit claim had been interrupted or suspended. After reviewing the evidence presented, we cannot find that the OWC abused its discretion by dismissing Mr. Hyginus's permanent residual benefit claim against Ochsner on the basis that it was prescribed.

Regarding Mr. Hyginus's medical benefit payment claim, pursuant to La. R.S. 23:1209(C), he would have had a three-year prescriptive period to file his claim commencing from the time the alleged last payment was made by Ochsner. In his original disputed claim, Mr. Hyginus alleged that medical benefit payments were terminated by Ochsner on December 1, 2022. In his amended disputed claims, he alleged that the last payment was issued on January 17, 2024. Even when considering the earliest alleged date of the termination of medical benefit payments, December 1, 2022, Mr. Hyginus would have had until December 1, 2025 to file a claim for the medical benefits. The March 20, 2024 filing of his disputed claim with the OWC was well-within the time delay for filing his medical benefit claim and was not prescribed on its face. Thus, it was Ochsner's burden to prove that the medical benefit claim was prescribed. Ochsner failed to present any evidence, e.g., an affidavit or deposition testimony from an Ochsner representative stating the last date of payment, if any, showing that the claim was prescribed. Accordingly, we find the OWC abused its discretion in finding that Hyginus's medical benefit claim was prescribed and dismissing that claim against Ochsner.

Prematurity

Mr. Hyginus alleges that the OWC erred in finding his disputed claim to be premature. He argues that either payment for medical treatment or discontinuation of payments for medical treatment should be reviewable through the filing of Form 1008, as he did with his disputed claim. He contends that his claim for medical benefit payments is in accordance with the provisions of Louisiana law.

Ochsner avers that its exception of prematurity was properly maintained and Mr. Hyginus's medical treatment claim was correctly dismissed. It argues that workers’ compensation law mandates the initiation of a request for medical treatment via an LWC-WC-1010 form. It further argues that, in the event of a dispute regarding medical treatment, the dispute must first be filed with the Office of Medical Director via an LWC-WC-1009 form. Ochsner contends that Mr. Hyginus failed to present any evidence that he or his healthcare provider followed the procedures set forth in La. R.S. 23:1203.1.

An action will be deemed premature when it is brought before the right to enforce it has accrued. Wilson v. St. Helena School Board, 18-1532 (La. App. 1 Cir. 6/3/19), 393 So.3d 358, 360, citing La. C.C.P. art. 423. The exception raising the objection of prematurity is generally utilized in cases where the law has provided a procedure for a claimant to seek administrative relief before resorting to judicial action. Id.

An employer's obligation to provide medical treatment for his injured employee is governed by La. R.S. 23:1201, et seq. Soniat v. Crown Buick and Risk Management Services, 14-489 (La. App. 5 Cr. 12/16/14), 166 So.3d 278, 282. Pursuant to the Louisiana Administrative Code, “medically necessary treatment” includes services that are in accordance with the medical treatment Guidelines and are clinically appropriate and effective for the patient's illness, injury, or disease. Daniels v. State Through Department of Transportation and Development, 52,750 (La. App. 2 Cir. 7/17/19), 275 So.3d 998, 1005. Generally, an employee must receive prior approval from his employer before he seeks non-emergency medical attention for a work-related accident or injury. Id. at 1006.

La. R.S. 23:1203.1(K) provides,

After the issuance of the decision by the medical director or associate director of the office, any party who disagrees with the decision may then appeal by filing a “Disputed Claim for Compensation”, which is LWC Form 1008, within forty-five days of the date of the issuance of the decision. The decision may be overturned when it is shown, by clear and convincing evidence, the decision of the medical director or associate medical director was not in accordance with the provisions of this Section.

In his disputed claim for compensation, Mr. Hyginus sought medical benefits that were allegedly terminated by Ochsner, indicating a dispute regarding medical treatment. At the hearing on the motion to dismiss, Mr. Hyginus was allowed an opportunity to present evidence of his medical benefit payment claim. He failed to present any relevant evidence of his properly submitted medical claims in compliance with La. R.S. 23:1203.1 for consideration by the OWC. While Mr. Hyginus is correct in his position that filing a disputed claim for compensation is a proper mechanism for payment of medical treatment or discontinuation of payments for medical treatment, he fails to acknowledge that a Form 1008 is to be filed after the issuance of the decision by the medical director or associate director of the office. Based upon the evidence presented, we find Mr. Hyginus's medical benefit claim in his Form 1008 was premature.

Accordingly, after considering the opportunities Mr. Hyginus had to present evidence that his medical benefit payment claim was properly filed, we dismiss his claim with prejudice. Based upon the findings in this opinion, we pretermit discussion of Mr. Hyginus's remaining assignments of error.

DECREE

For the foregoing reasons, we affirm the OWC's judgment that dismissed Mr. Hyginus's workers’ compensation claim against Ochsner as amended.

AFFIRMED AS AMENDED

FOOTNOTES

1.   Sedgwick Claims Management Services, Inc. and Broadspire also joined in Ochsner's pleading.

2.   The appellate record does not contain a minute entry or a transcript of the September 5, 2024 hearing. Therefore, we cannot determine whether evidence was accepted by the OWC.

3.   In workers’ compensation matters, the technical rules of evidence are relaxed but findings must nonetheless be based on “competent evidence.” Lummus v. Shoney's, 99-90 (La. App. 5 Cir. 6/1/99), 738 So.2d 117, 120.

4.   The letter stated, “this is not a worker's compensation case. Mr. Anthony Hyginus was going home and not on duty at the time when his injuries occurred. For the foregoing reasons, Mr. Hyginus’ case is a tort case.”

JOHNSON, J.