It’s not unusual for workers’ compensation claims to be denied outright, especially if the worker is not represented by an experienced attorney.
In many cases, workers have to fight for benefits, and it sometimes requires a substantial amount of evidence to establish certain aspects such as causation, whether the injury or illness occurred in the scope and course of employment and the full extent of claimant’s disability.
In the recent case of Ellis v. Key City Furniture, the North Carolina Court of Appeals affirmed a denial of benefits to an employee who failed to show she was unable to earn the same wages as she died prior to layoff. The court further held that the North Carolina Industrial Commission had not erred in giving diminished weight or totally disregarding her physician’s opinion of her injuries.
This is one of the reasons why having ample evidence of each aspect of the case is so important. Presenting the opinion of just one doctor to testify in your favor may not be sufficient in your case.
According to court records, plaintiff worked for 35 years as a coordinator at a furniture store. Her primary requirement was assembling pieces of furniture. She was often required to bend, lift, reach overhead, twist and stand for long periods.
In 2008, she was hurt when she tripped over a cushion located on the floor of the work room.
When she filed a claim for workers’ compensation, her employer and its insurer agreed to pay the medical claim, but noted they would reserve the right to later deny the claim. It would pay the medical bills, but not disability compensation and refused to admit plaintiff was disabled.
The following year, plaintiff saw an orthopedic surgeon for treatment of her ongoing leg pain. She did have lateral recess stenosis and disc herniation, but the doctor believed she was at maximum medical improvement and opined no further intervention was necessary. He assigned her a five percent personal impairment rating due to he back injury, and she kept working full-time.
Then in spring 2010, she was hurt again at work when she slipped on strings on the floor. Again, she hurt her back. She sought treatment from the same orthopedic surgeon, who determined she wasn’t a good candidate for surgery, declined to change her impairment rating and released her to full-duty work. He did though refer her to a neurologist for another opinion.
The neurologist recommended physical therapy and pain medication.
She continued to work full-time until her second injury, but then soon after lost her job as part of a company-wide lay-off. The company shut down completely the following year.
Prior to the closure, defendants authorized plaintiff to see another neurosurgeon who again assigned her a five percent permanent disability rating. He recommended no other treatment aside from pain management.
She was not satisfied with this, and sought a second opinion from one of a list of approved physicians. The insurer wrote the doctor to say the evaluation was only authorized for a second opinion on the impairment rating. But the doctor, a neurosurgeon, did not think she should be assigned a rating yet because she wasn’t yet at maximum medical improvement.
Defendants then requested a hearing to assert plaintiff was at maximum medical improvement (per the opinion of other physicians) and had a five percent impairment rating.
Commissioner entered an opinion ordering defendants to pay for additional diagnostic testing, but denying plaintiff’s claim for ongoing disability.
Both appealed. Full commission found plaintiff had sustained a compensable injury, but gave less weight to the opinion of the final doctor she saw, who had only treated her on one occasion. It affirmed her 5 percent injury rating, and noted plaintiff did not reach her burden of proving disability by producing evidence she was not capable of earning her pre-injury wages after the injury.
Contact the Carolina work injury lawyers at the Lee Law Offices by calling 800-887-1965.
Ellis v. Key City Furniture, Aug. 18, 2015, North Carolina Court of Appeals
More Blog Entries:
Holliday v. Tropical Nut & Fruit Co. – Workers’ Comp for Laser Tag, Aug. 15, 2015, Greensboro Workers’ Compensation Lawyer Blog