Lancer v. Albemarle Hospital
I.C. NO. 571518.
| N.C. Indus. Comm. | Mar 23, 2011Background
- Plaintiff sustained a compensable low back injury on November 7, 2005 arising from work for defendant-employer; Key Risk Insurance was the carrier.
- Defendants admitted compensability on November 14, 2005 and paid benefits until a Form 24 suspension was approved June 8, 2006.
- Dr. Spear, plaintiff’s authorized treating physician, opined plaintiff was at maximum medical improvement and capable of returning to work as of April 10, 2006.
- Plaintiff later sought treatment from unauthorized physicians, including Dr. Nicholas, without Commission authorization, beginning around October 2006.
- Deputy Commissioner Deluca’s April 21, 2007 Opinion and Award denied claims for treatment by unauthorized physicians; plaintiff did not appeal that decision.
- Full Commission held plaintiff failed to prove a change of condition and denied indemnity; awarded ongoing medical treatment only with authorized providers.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Temporary total disability | Bailey-like argument for continued TTD. | No substantial change in condition; no further TTD. | Denied; no change of condition proven. |
| Permanent total disability | Nicholas opinion shows permanent disability. | Spears’ MMI finding controls; no permanent total disability. | Denied; Dr. Spear weighed more; no permanent total disability. |
| Additional medical compensation | Entitled to treatment from Dr. Nicholas and others. | Unauthorized treatment barred by prior award and estoppel. | Denied; only authorized medical treatment compensable. |
| Change of condition | Condition worsened post-award; entitlement to benefits. | No substantial change in physical capacity; condition stable. | Denied; no substantial change of condition. |
| Treating physician authorization | Should be allowed to continue with Nicholas due to impairment. | Collateral estoppel/res judicata precludes; prior denial stands. | Denied; collateral estoppel and prior denial control. |
Key Cases Cited
- King v. Grindstaff, 284 N.C. 348 (1973) (collateral estoppel scope in workers' compensation)
- Whitacre P'ship v. Biosignia, Inc., 358 N.C. 1 (2004) (res judicata applies in workers' compensation)
- Bailey v. Sears Roebuck Co., 131 N.C. App. 649 (1998) (burden to prove change of condition; capacity to earn wages)
- Bryant v. Weyerhaeuser Co., 130 N.C. App. 135 (1998) (res judicata elements in workers' compensation)