North Carolina Appeals Court Reverses Workers Compensation Award

NORTH CAROLINA APPEALS COURT REVERSES WORKERS COMPENSATION AWARD

A recent North Carolina Court of Appeals opinion took a close look at issues of medical causation and liability in North Carolina workers’ compensation cases. The case, Gross v. Gene Bennett Co., involved a claim for workers’ compensation benefits from a welder and steel fabricator who injured his back after falling through a suspended ceiling over ten feet to a concrete floor.

The plaintiff initially missed about two months of work after receiving medical treatment and occupational therapy and receiving a medical authorization to return to work. He applied for and received work comp benefits from his employer for the medical expenses. But several months later, he sought further diagnosis from an orthopedic surgeon, and two MRIs revealed bulging discs, extrusions and herniations at several locations along his spine.

Because his chronic back injury was worse than originally thought and had interfered with his return to work, plaintiff applied for further benefits with the North Carolina Industrial Commission. The Commission concluded that his ongoing lower back condition was a compensable result of his original injury, and awarded him temporary total disability as well as all related medical expenses that had accrued since his original release to return to work.

Plaintiff’s employer appealed the decision based on the Industrial Commission’s application of a legal doctrine known as the Parsons presumption. In a 1997 case, Parsons v. Pantry Inc., the Court of Appeals held that the Commission can presume that additional medical treatment has a causal relationship to a legally determined compensable injury. In such a case, the legal burden of proof shifts to the employer to show that the present discomfort is unrelated to the original injury.

Appellate Panel Agrees With Employer and Reverses Disability Determination

The three-judge panel reviewed the case record and found that there had been no previous finding of a compensable injury by the Industrial Commission because the original workers’ comp benefits proceedings had only been concerned with medical expenses. The Parsonspresumption is only appropriate where one of three things has happened: the employer was previously found to be liable for a compensable injury, the employer admitted to compensability, or the employer and employee had entered an agreement regarding compensability.

The court cited a 1953 case, Biddix v. Rex Mills, for the principal that acceptance of a claim on a medicals-only basis “cannot in any sense be deemed an admission of liability.” Absent the legal presumption, the court reviewed the record to consider whether the plaintiff’s orthopedic surgeon had established a conclusive relationship between the original injury and the chronic symptoms that emerged later.

They found that the orthopedic surgeon’s opinion regarding medical causation did not exceed the level of mere possibility, and therefore concluded that the Industrial Commission’s findings of fact and resulting disability determination were not supported by sufficient evidence. One aspect of the record that troubled the appellate panel was the fact that the plaintiff had reported a history of prior back injury during his examination with the first doctor immediately following the accident. Based on this assessment, the Court of Appeals reversed the Commission’s decision and remanded the case for entry of a new opinion and award that did not provide benefits for the later diagnosis of injury.

Emphasizing the Importance of Enlisting Experienced Legal Counsel

As this case proves, workers’ compensation cases can be surprisingly complex and eligibility for benefits should never be taken for granted. It seems unfair that a worker injured in a construction site accident, who then misses work for several weeks and does his best to return but cannot due to disabling pain, will not be compensated for what seems like an obvious work-related injury. But courts take issues of causation extremely seriously, and a North Carolina lawyer must work diligently to help a client secure benefits when an employer is not willing to follow through on its obligations.

This is one reason why it is important to speak with an NC work comp attorney before the original application process. An experienced lawyer can explain obscure concepts like theParsons presumption and help a client understand that the application for benefits must be backed by thorough and unambiguous medical records and testimony.

Whether the injury occurred during a trucking accident, construction accident or other work-related circumstances, a lawyer with experience before the North Carolina Industrial Commission and state appellate courts can be a vital asset when one’s future financial health is at stake. An attorney who handles North Carolina personal injury claims can also assess the possibility of a third-party claim against a wrongdoer who is not your employer.