Workers who are severely and permanently injured as a result of an occupational accident or illness may be entitled to permanent total disability benefits.
There are many different ratings of disability following a work injury in North Carolina or South Carolina that may entitle a worker to long-term benefits. However, only permanent total disability (PTD) benefits may be paid for he duration of one’s life. All others cut off after a maximum 500 weeks (almost 10 years). That includes workers’ compensation death benefits.
But the instances in which lifetime benefits may be afforded are rare and include only the most serious of cases: Severe brain injury, quadriplegia, paralysis or extensive burns over more than a third of the body.
Essentially, one must prove he or she is completely and permanently disabled, as defined by state statute, and are unable to work in any capacity. If one is permanently and completely disabled but does not have one of the aforementioned conditions, he or she may still be entitled to PTD – but only for up to 500 weeks.
In order to succeed in a workers’ compensation case asserting PTD, one must prove a number of elements – not the least of which is causation. That is, the injury or illness arose in the course and scope of employment.
That was apparently one of the challenges in Dallas National Insurance Co. v. De La Cruz. According to news reports of the case, plaintiff worked as a cook at a restaurant in El Paso, near the borders of Mexico and New Mexico.
While working, the employee reportedly fell and injured both her knee and back. That was in February 2004. The following month, she was released by doctors to work light-duty. However, soon after doctors decided she could not, in fact, perform even modified duties. She went on to have surgery on her back and her knee. However, her pain and numbness in both regions persisted.
Five years after the injury, plaintiff filed a petition with the state division of workers’ compensation for a lifetime of benefits. She asserted the workplace fall she suffered caused her permanent and total disability. Although the state workers’ compensation division denied that request, a district court ruled – and an appellate court later affirmed – a finding of PTD for the worker. In its ruling, the appeals court noted the injuries caused pain to radiate down to her feet, resulting in her use of a cane and loss of use of her feet.
Insurer appealed that ruling and the Texas Supreme Court reversed. The court ruled injured workers can only obtain lifetime benefits for injuries that were work-related and only for the body parts that were directly injured in the accident. In this case, pain in her feet could not be considered “damage or harm” to the physical structure of the body, sufficient to warrant lifetime benefits.
The high court noted that while the back and knee injury did affect her legs, there was no causal evidence presented to show those injuries also affected her feet.
This is not to say the case would have been impossible to win, but plaintiff failed to present enough solid medical evidence to prove that the work-related injury caused the damage to her feet that rendered her permanently and totally disabled.
If you have been injured at work, contact the Lee Law Offices at 800-887-1965.
Injured restaurant worker denied lifetime comp benefits, Aug. 31, 2015, By Sheena Harrison, Business In ance
More Blog Entries:
Ellis v. Key City Furniture – Denial of Disability Claim, Aug. 22, 2015, Asheville Workers’ Compensation Lawyer Blog