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