A recent North Carolina Court of Appeals opinion analyzed issues of medical causation and liability in the state's workers comp cases.
The case, Gross v. Gene Bennett Co., involved a claim for workers comp benefits from a welder and steel fabricator who injured his back after falling through a suspended ceiling more than 10 feet to a concrete floor. (WCxKit)
According to management, the plaintiff initially missed approximately two months of work after obtaining 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 costs. But several months later, he wanted further diagnosis from an orthopedic surgeon, and a pair of MRIs showed bulging discs, extrusions and herniations at several locations along his spine.
Because his chronic back injury was worse than originally thought and had impacted his return to work, plaintiff applied for further benefits with the North Carolina Industrial Commission. The Commission came to the conclusion that his ongoing lower back condition was a compensable result of his original injury, and awarded him temporary total disability along with all related medical expenses that had accrued since his original release to return to work.
Plaintiff's employer appealed the ruling 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 added medical treatment has a causal relationship to a legally determined compensable injury. In such a case, the legal burden of proof moves to the employer to demonstrate that the present discomfort is unrelated to the original injury.
The three-judge panel reviewed the case record and found that there had been no prior finding of a compensable injury by the Industrial Commission due to the fact the original workers comp benefits proceedings had only been concerned with medical expenses. The Parsons presumption is only appropriate where one of three things has occurred: 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 as it relates to compensation.
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 analyzed 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.
The court said 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 bothered the appellate panel was the fact that the plaintiff had noted a history of previous back injury during his examination with the first doctor immediately after the accident. (WCxKit)
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 offer benefits for the later diagnosis of injury.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
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