Opinion
I.C. NO. 016391.
Filed 4 April 2002.
This matter was reviewed by the Full Commission on 29 October 2001 upon appeal of plaintiff from an Opinion and Award by Deputy Commissioner Amy L. Pfeiffer filed on 7 June 2001. In lieu of a hearing before the Deputy Commissioner, the parties submitted a set of stipulations.
APPEARANCES
Plaintiff: Law Offices of Kathleen G. Sumner, Greensboro, North Carolina; Jeanette L. Foust, appearing.
Defendants: Cranfill, Sumner Hartzog, Raleigh, North Carolina; Jonathan C. Anders, counsel of record; Jaye E. Bingham, appearing.
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Upon review of the competent evidence of record with reference to the errors assigned, and finding no good grounds to reconsider the evidence, receive further evidence, rehear the parties or their representatives, or amend the award, the Full Commission AFFIRMS and ADOPTS the Opinion and Award of the Deputy Commissioner.
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Accordingly, the Full Commission finds as fact and concludes as matters of law the following, which were entered into by the parties as:
STIPULATIONS
1. The parties are correctly designated and named in the above caption.
2. The carrier on the risk for workers' compensation purposes is Travelers Insurance Company.
3. An employment relationship existed between plaintiff and defendant-employer on 27 October 1998. Furthermore, defendant-employer regularly employs three or more employees.
4. The parties are subject to and bound by the provisions of the North Carolina Workers' Compensation Act.
5. Plaintiff's average weekly wage on 27 October 1998 was $787.20. This yields a compensation rate of $525.06.
6. On 27 October 1998, plaintiff was working as an alpha shear operator for defendant-employer. On that date, plaintiff, while threading a frame, stepped backwards on a metal plate, twisted her left ankle, and fell backwards. The employee injury report, dated that same day, states that plaintiff sprained her left ankle and bruised her left elbow. According to the Employee Dispensary Pass dated 27 October 1998, plaintiff's left ankle was swollen and had a limited range of motion. Plaintiff also complained of severe pain when standing. Plaintiff was sent to Highsmith-Rainey Hospital Emergency Room.
7. Defendants have paid all medical compensation for treatment of plaintiff's left ankle and left elbow. Moreover, defendant-employer provided appropriate light duty for plaintiff during all relevant periods of medical restrictions so there was no lost time from work as a result of plaintiff's 27 October 1998 injury by accident.
8. In addition to the deposition transcript of Dr. Wyker and the records attached thereto, the parties stipulated into evidence in this matter a packet of medical records marked as stipulated exhibit one. Thereafter, plaintiff submitted additional records from Dr. Logel that should have been included in the packet of stipulated medical records.
9. The issue to be determined by the Commission is whether plaintiff's left hip condition and the resulting need for medical treatment are causally related to plaintiff's compensable 27 October 1998 injury by accident.
10. Defendants further reserved the right to obtain an independent medical evaluation.
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The Full Commission adopts the findings of fact found by the Deputy Commissioner and finds as follows:
FINDINGS OF FACT
1. Plaintiff injured her left ankle and left elbow when she slipped and fell backwards at work on 27 October 1998. Plaintiff completed an injury report, indicating that she had twisted her ankle and bruised her elbow.
2. Plaintiff reported that same day to the dispensary where she complained of a swollen and painful left ankle with limited range of motion, and a bruised left elbow. Plaintiff was sent to Highsmith-Rainey Memorial Hospital, where she reported the following day. X-rays were taken of plaintiff's left ankle and left elbow. Plaintiff was diagnosed with a sprained left ankle and a left elbow contusion, and was given crutches because she was unable to bear weight on her injured ankle.
3. Plaintiff was placed on light duty after this injury, and she did not miss any time from work because defendant-employer provided her with appropriate suitable light duty work. Defendants admitted liability for plaintiff's injury by accident and paid for all medical treatment for her ankle and elbow.
4. Plaintiff then began treating with Dr. Robert J. Logel, an orthopedist, on 4 November 1998. At this evaluation, plaintiff informed Dr. Logel that her elbow problems had basically resolved, but that she had continued to have ankle pain. Dr. Logel prescribed ankle exercises and partial weight-bearing.
5. In January 1999 plaintiff returned to full-duty work with no restrictions and no permanent functional impairment. By 26 January 1999, Dr. Logel noted that plaintiff had only occasional ankle pain, no elbow pain, and had stopped taking medication. Dr. Logel released plaintiff from his care at this time.
6. The first mention of plaintiff's complaints of left hip pain appeared in August 1999, ten months after the admittedly compensable injury by accident, when plaintiff returned to Dr. Logel and reported that "[s]everal months ago" she started having pain in her left hip. Dr. Logel diagnosed probable early arthritis. The medical note from 19 August 1999 does not attribute plaintiff's hip complaints to any particular cause or event.
7. The first mention in the employer's records of problems with plaintiff's left hip came on 16 October 1999 when plaintiff asked to be seen at the dispensary for left hip pain. At this time, almost exactly one year after the admittedly compensable injury by accident, plaintiff related her hip pain to the fall at work on 27 October 1998. The record does not indicate that defendants paid medical compensation for treatment of plaintiff's left hip.
8. From this point on, the medical records attribute plaintiff's left hip pain to the 27 October 1998 injury by accident, and most physicians appeared willing to accept plaintiff's accounts that the problems with her left hip surfaced at or shortly after the 27 October 1998 fall at work. Plaintiff was evaluated and/or treated by a number of physicians, including Drs. Vaught, Jones, Dalldorf, and Wyker, for her left hip complaints. Plaintiff also underwent short courses of chiropractic treatment and physical therapy. Most of these physicians, with the exception of Dr. Robert Wyker, treated plaintiff on only one or at most several occasions.
9. Plaintiff first reported to Dr. Wyker, an orthopedic surgeon, on 31 August 2000. According to Dr. Wyker's notes, plaintiff again attributed her hip complaints to the 27 October 1998 injury by accident. Plaintiff reported to Dr. Wyker that she had experienced persistent back and left hip pain over the preceding two years. Plaintiff continued to treat with Dr. Wyker, and on 20 October 2000 Dr. Wyker performed an arthoscopy of plaintiff's left hip. The procedure confirmed a recent MRI diagnosis of torn labrum. Dr. Wyker debrided and cleaned the torn portion of plaintiff's hip.
10. As a result of the surgical procedure on her left hip, plaintiff was totally disabled beginning 18 October 2000. Dr. Wyker indicated in his deposition that plaintiff was totally disabled for a period of approximately six weeks post-surgery, and thereafter she was probably capable of light-duty, sedentary work. Dr. Wyker assigned a permanent partial impairment rating of ten percent to plaintiff's left leg.
11. Dr. Wyker, the only medical expert deposed, stated that plaintiff's left hip problems could not have developed solely due to degenerative changes, but that some trauma had to have been involved. Due to plaintiff's accounts of the fall on 27 October 1998 and her history that her left hip had given her trouble since the date of the injury, Dr. Wyker initially believed that the 27 October 1998 injury by accident was the cause of plaintiff's subsequent left hip problems.
12. Plaintiff argues in her brief that the fact that she was on crutches for a short period of time after the injury by accident decreased the pressure on her hip, and therefore even though her hip problems were caused by the injury, she did not notice or experience problems with her hip for a period of time. In addition, plaintiff also argues that problems with endometriosis also masked her hip problems and pain. When presented with these contentions at his deposition, Dr. Wyker agreed that using the crutches or the gynecological problems might have masked a hip injury. However, he went on to state that he still would expect an individual with a hip injury to feel and notice pain. Further, as soon as plaintiff started weight bearing, if the hip pain did not show up right away, Dr. Wyker felt that fact made it difficult to determine the cause of the injury.
13. Upon further review of the employer and medical records in this matter which show that plaintiff failed to mention left hip pain to the employer or any physician until ten months after the accident, Dr. Wyker amended his opinion to state and the Commission so finds that the 27 October 1998 injury by accident did not cause plaintiff's hip condition. The problems with plaintiff's hip were caused by trauma, and had plaintiff injured her hip on 27 October 1998, according to Dr. Wyker, she would have experienced pain and problems shortly after the injury. Plaintiff also probably would have sought medical treatment sooner than ten months after the injury by accident if this accident was indeed the cause of plaintiff's hip problems.
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Based upon the foregoing stipulations and findings of fact, the Full Commission concludes as follows:
CONCLUSIONS OF LAW
1. In a claim for additional compensation for medical treatment, the treatment must be "directly related to the original compensable injury." Pittman v. Thomas Howard, 122 N.C. App. 124, 130, 468 S.E.2d 283, 286, disc. review denied, 343 N.C. 513, 471 S.E.2d 18 (1996). It is the burden of the injured worker to prove that the injury or condition being treated is causally related to the compensable injury by accident. Snead v. Mills, Inc., 8 N.C. App. 447, 174 S.E.2d 699 (1970). The North Carolina Court of Appeals stated in Parsons v. Pantry, Inc., 126 N.C. App. 540, 485 S.E.2d 867 (1997) that once the Commission has found a claim compensable, a rebuttable presumption arises that the treatment is directly related to the original compensable injury. The burden then shifts to defendants to prove that the medical treatment is not directly related to the compensable injury. Id. In Reinninger v. Prestige Fabricators, 136 N.C. App. 225, 523 S.E.2d 720 (1999), the Court of Appeals applied the Parsons presumption to a case in which the parties entered into a Form 21 Agreement for Compensation which was approved by the Commission and therefore constituted an "award" of the Commission, pursuant to N.C. Gen. Stat. § 97-82.
2. In the case at bar, defendants admitted the compensability of plaintiff's injury by accident on a "medicals only" basis. Plaintiff missed no time from work due to the injuries to her left elbow and ankle and therefore no indemnity compensation was paid by defendants. The facts and circumstances present in Parsons and Reinninger, supra, are not present in this case. In both Parsons and Reinninger, supra, the treatment involved the same condition or body part as the original injury (headaches in Parsons, the back in Reinninger). Here, plaintiff now claims injury to her left hip, but the original compensable injury was to her left elbow and ankle. In addition, in the case before us, there is no form agreement for payment of compensation or award of the Commission. Therefore, the Parsons presumption does not apply under the circumstances present in this case and the burden remained on plaintiff to establish a causal relationship between the original compensable injury and the left hip condition. Based upon the greater weight of the medical evidence of record, plaintiff failed to sustain her burden of proof. Plaintiff's left hip condition is not causally related to plaintiff's admittedly compensable injury by accident. See, Porter v. Fieldcrest Cannon, Inc., 133 N.C. App. 23, 514 S.E.2d 517 (1999).
3. Accordingly, plaintiff is not entitled to additional medical or indemnity benefits as a result of her left hip problems. N.C. Gen. Stat. §§ 97-2(6), -25, -29.
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Based on the foregoing findings of fact and conclusions of law, the Full Commission affirms the holding of the Deputy Commissioner and enters the following:
ORDER
1. Under the law, plaintiff's claim to have medical and indemnity benefits paid as a result of her hip problems must be, and the same is HEREBY DENIED.
2. Each party shall bear its own costs of this proceeding.
3. Defendants shall pay a reasonable expert witness fee of $500.00 to Dr. Wyker for his deposition testimony in the case.
This the _____ day of April 2002.
S/_____________________________ LAURA KRANIFELD MAVRETIC COMMISSIONER
CONCURRING:
S/_____________________________ BUCK LATTIMORE CHAIRMAN
DISSENTING:
S/_____________________________ THOMAS J. BOLCH COMMISSIONER
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Defendants admitted liability for Ms. Santiago's October 27, 1998 injury by accident and have paid for all medical treatment for her ankle and elbow. As soon as an employee claims he or she is entitled to compensation, the employer has the right to require the employee to submit to an examination with one of its authorized physicians. N.C. Gen. Stat. § 97-27(a) (1999). One of the implicit purposes of this requirement is to enable the employer to ascertain whether the injury is work-related or not and thus whether the claim is indeed compensable. Prior to acceptance of the claim as compensable, the employer only has the right to require its employee to submit to an examination. Kanipe v. Lane Upholstery, ___ N.C. App. ____, 540 S.E.2d 785 (December 29, 2000).
However, the right to require an employee to submit to an examination under N.C. Gen. Stat. § 97-27 (a), does not equal a right to direct medical treatment in general. Kanipe v. Lane Upholstery, supra. The employer may only direct medical care for compensable claims.
Until Kanipe neither our courts nor our legislature has ever explicitly articulated at what point this right of the employer to direct medical treatment for a compensable injury attaches. The Commission treats the employer's acceptance of liability as the triggering point. Id.
When Ms. Santiago slipped and fell backwards at work on October 27, 1998, she reported her injury to her employer. She initially treated at the emergency room and then with Dr. Logel, an orthopedic physician. Defendants paid for and directed all treatment rendered by Dr. Logel. Dr. Logel released Ms. Santiago from his care on January 26, 1999, but she returned to him, the treating physician, as she was allowed to do under the Act, in August 1999 with complaints of left hip pain that had been present for several months. On referral by Dr. Logel, Ms. Santiago had an x-ray of her left hip and a lumbar MRI and saw Dr. Vaught, a neurosurgeon. In Dr. Vaught's medical notes and medical notes of doctors that Ms. Santiago saw for treatment subsequent to Dr. Vaught, causation of her left hip pain and injury was always attributed to her October 27, 1998 fall at work.
When Ms. Santiago's hip pain became so unbearable that she was forced to seek treatment, she did so with her authorized treating physician, Dr. Logel. She knew that the hip pain was from her fall at work and therefore she returned to defendants' doctor rather than her own physician. She thereafter followed his referrals in her search to discover the reason for her symptoms. The employer directed and paid for medical care for her left ankle and this claim remained open.
Under Kanipe, the point at which the employer can direct medical care is when they accept the claim. After accepting the claim, the employer controls the medical treatment of the injured employee, absent an order by the Commission.
Because the employer directed and paid for medical care and did not give Ms. Santiago the option of seeing a doctor of her own choosing, the employer cannot now deny liability for the left hip claim, since Dr. Logel, the treating physician directed medical care. Any medical treatment authorized or directed by the treating physician is authorized, absent the defendant proving to the satisfaction of the Commission that such treatment is not related. Thus, all medical treatment by the treating physician or authorized by the treating physician is presumed related. Parsons v. The Pantry, 126 N.C. App. 540, 485 S.E.2d 867 (1997).
The defendants have the burden of proving that the treatment for Ms. Santiago's left hip was not causally related to her October 27, 1998 injury.
In this case the Deputy Commissioner and the majority erred when they incorrectly placed the burden on Ms. Santiago to prove that her left hip condition was causally related to her original compensable injury. In compensable injuries the burden shifts to defendant to prove that the medical treatment is not related. Thus, the deputy commissioner and majority did not give Ms. Santiago the benefit of the Parsons presumption.
It is axiomatic that plaintiff has the burden of initially establishing a causal relationship between a work-related incident and her medical conditions. See Snead v. Mills, Inc., 8 N.C. App. 447,451, 174 S.E.2d 699, 702 (1970) ("[a] person claiming benefit of compensation has the burden of showing that the injury complained of resulted from the accident"); Harvey v. Raleigh Police Dept., 96 N.C. App. 28, 384 S.E.2d 549, disc. review denied, 325 N.C. 706, 388 S.E.2d 454 (1989). However, once the initial burden is established the burden shifts to defendant to prove that the medical condition is not related. The North Carolina Court of Appeals held that Parsons stands for the proposition that the Commission incorrectly placed the burden on plaintiff to prove she sustained a compensable traumatic incident. Porter v. Fieldcrest Cannon, Inc., 133 N.C. App. 23, 514 S.E.2d 517 (1999).
In Parsons, the Commission awarded plaintiff her medical expenses and future medical treatment. Subsequently, the defendants refused to continue to pay for medical treatment beyond one visit to a neurologist. Another hearing was held, and the Commission held that the injured worker did not meet her burden to prove that the medical treatment was causally related to her original injury. Parsons, 126 N.C. App. at 541, 485 S.E.2d at 868. The Court of Appeals reversed, finding that once the claim is approved the burden shifts to the defendant to prove that the medical treatment is not related. Id. at 542, 485 S.E.2d at 869.
The Court of Appeals reaffirmed this holding in Reinninger v. Prestige Fabricators, 136 N.C. App. 225, 523 S.E.2d 720 (1999). "If additional medical treatment is required, there arises a rebuttable presumption that the treatment is directly related to the original compensable injury and the employer has the burden of producing evidence showing the treatment is not directly related to the compensable injury." Reinninger v. Prestige Fabricators, 136 N.C. App. 225, 523 S.E.2d 720 (1999).
In Ms. Santiago's case, defendants admitted that she sustained a compensable injury on October 27, 1998. They paid for and directed her medical treatment. When Ms. Santiago sought treatment for her left hip, she did so from her authorized treating doctor and followed his referrals for treatment. It would be unjust to shift the burden to Ms. Santiago to prove that her left hip problems are causally related to her original injury, when Dr. Logel, the treating physician, and all subsequent treating physicians opined that the left hip problems were related to her compensable injury. Particularly when defendants admitted compensability for this claim, and directed the medical treatment, defendants must carry the burden of proving that Ms. Santiago's left hip problems are not related to her original compensable injury.
This 27th day of March 2002.
S/_____________________________ THOMAS J. BOLCH COMMISSIONER