Workers’ comp disability payments to an employee injured in a work-related truck crash were cut off. Does he have to “re-prove” his injuries for the payments to continue?
Johnnie Wilkes worked for the City of Greenville, NC, as a landscaper. On April 21, 2010, Wilkes was driving a truck owned by the city when another vehicle ran a red light and struck the truck. Wilkes suffered head, rib, neck, back, pelvis and hip injuries, including a concussion.
Wilkes was out of work and continued to see doctors for back and leg pain, tinnitus (ringing in the ears), anxiety and depression, and sleep loss. Several months after the crash, a hearing was held on his case.
A deputy of the North Carolina Industrial Commission ordered the employer to pay Wilkes temporary total disability until he returned to work. The employer appealed to the full Commission.
The Commission concluded Wilkes was entitled to medical compensation for his tinnitus. But he failed to meet his burden of proof establishing he had anxiety and depression caused by the crash, according to the Commission, therefore he wasn’t entitled to medical compensation for those conditions. The Commission also found he wasn’t entitled to any disability payments after Jan. 18, 2011 because he hadn’t presented evidence of a reasonable job search.
The North Carolina Court of Appeals heard Wilkes’ case. The court vacated the decision on medical treatment for anxiety and depression and reversed the Commission’s decision not to award Wilkes temporary disability. The court said there was a presumption (that could be rebutted by the employer) that Wilkes’ anxiety and depression was related to his workplace injury.
The court noted a doctor had authorized Wilkes to return to sedentary work with permanent restrictions including lifting no more than 10 pounds with occasional walking and standing. The judges also found Wilkes had limited wage-earning capacity because he:
- was 60 years old at the time of the hearing
- had been employed either as a landscaper or in medium and heavy labor his entire adult life
- attended school only until the 10th grade
- was physically incapable of performing his job as a landscaper, and
- had an IQ of 65.
The court said a job search would be futile because of his physical limitations, age and education. Therefore, the Commission should have granted Wilkes total temporary disability.
Wilkes’ employer took the case to the North Carolina Supreme Court.
The City of Greenville argued the Court of Appeals shouldn’t have found there was a presumption that Wilkes’ anxiety and depression were related to his workplace injuries. The state’s highest court disagreed.
The Court of Appeals had adopted the presumption in a previous case, Parsons v. Pantry Inc.
In Parsons, a store employee was shot multiple times with a stun gun. At a Commission hearing, the store clerk showed her injuries were the result of the workplace incident. Later, when the employer didn’t pay her medical expenses, primarily for headaches, the Commission agreed she shouldn’t be compensated because she hadn’t introduced evidence that the headaches were related to her work injury.
But the Court of Appeals ruled in Parsons that “to require [the injured worker] to re-prove causation each time she seeks treatment for the very injury that the Commission has previously determined to be the result of a compensable accident is unjust and violates our duty to interpret the [workers’ comp] Act in favor of injured employees.”
The presumption that additional medical treatment is directly related to the compensable injury has since become known in North Carolina as the Parsons presumption.
The state supreme court found Parsons applied in Wilkes’ case: He’s entitled to a presumption that additional medical treatment is related to his compensable conditions. Wilkes qualified for additional treatment for tinnitus, anxiety and depression.
On the question of whether Wilkes qualified for disability, the court said the Commission must take into account age, education, previous work experience and other preexisting conditions when determining loss of the ability to work. No expert testimony is required to show this.
But the state supreme court said the Commission hadn’t determined whether Wilkes’ tinnitus and any related symptoms affected his ability to work. So it remanded the case to the Commission to consider that and the other factors together.
Given Wilkes’ age, education and physical abilities, it’s quite possible the Commission will find, on remand, that he should receive disability benefits.
(Johnnie Wilkes v. City of Greenville, Supreme Court of NC, No. 368PA15, 6/9/15)