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State v. State
I.C. NO. 142566.
N.C. Indus. Comm.
Nov 3, 2010
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Background

  • Plaintiff sustained a compensable injury by accident on November 3, 2008 while employed by Aube's Inc.
  • Defendants admitted liability via Form 60, with temporary total disability payments and later benefits under Form 62.
  • Plaintiff underwent multiple medical evaluations, including Dr. Kim's recommendation for a discogram and possible L5-S1 fusion.
  • Independent medical opinions varied: Dr. Brigham (no surgery), Dr. Ellison (no discogram/surgery), Dr. Carlton (surgery possible but later cautious), with surveillance suggesting activity inconsistent with severe disability.
  • Medical case management by Stacey Bergner coordinated care and influenced treatment timelines, while Plaintiff ultimately sought continued medical treatment and surgical options.
  • Full Commission later determined no ongoing disability and limited medical authority, with Dr. Ellison as the authorized treating physician.

Issues

Issue Plaintiff's Argument Defendant's Argument Held
Whether Plaintiff has ongoing disability. Plaintiff contends ongoing disability is established by pain and restrictions. No ongoing disability; Plaintiff released to full duty and medical opinions do not support continuous disability. No ongoing disability established; benefits may be terminated.
Whether Plaintiff is entitled to additional medical treatment, including a change of physicians. Plaintiff seeks continued care and a change of treating physician. Employer may control initial treating physician; change requires authorization; no mandatory discogram treatment. Disallowed; no entitlement to requested discogram or change of treating physician.
Whether the discogram ordered by Dr. Kim was properly authorized and timely. Discogram is necessary to determine pain source and potential surgery. Discogram not reasonably required medical treatment and authorization issues were unresolved. Discogram not authorized or required as medical treatment.
Whether Defendants delayed the discogram and related surgical planning. Delays worsened Plaintiff's condition and hindered timely treatment. Delays were not proven to be causative of damages or disability. No entitlement established based on delay.

Key Cases Cited

  • Sims v. Charmes/Arby's Roast Beef, 142 N.C. App. 154, 542 S.E.2d 277 (N.C. App. 2001) (Form 60 admission does not create disability presumption)
  • Johnson v. S. Tire Sales Serv., 358 N.C. 701, 599 S.E.2d 508 (N.C. 2004) (presumption of disability is limited; burden proof required absent Form 21/26 or prior award)
  • Coppley v. PPG Indus., Inc., 133 N.C. App. 631, 516 S.E.2d 184 (N.C. App. 1999) (disability burden shifting to employer after initial showing)
  • Cross v. Falk Integrated Technologies, Inc., 190 N.C. App. 274, 661 S.E.2d 249 (N.C. App. 2008) (employer must show suitable jobs and ability to obtain them)
  • Franklin v. Broyhill Furniture Indus., 123 N.C. App. 200, 472 S.E.2d 382 (N.C. App. 1996) (criteria for disability and wage-earning capacity guidance)
Read the full case

Case Details

Case Name: State v. State
Court Name: North Carolina Industrial Commission
Date Published: Nov 3, 2010
Docket Number: I.C. NO. 142566.
Court Abbreviation: N.C. Indus. Comm.