HASSELL HYLER v. GTE PRODUCTS CO. AND AMERICAN MOTORISTS INSURANCE CO.
No. 96PA92
IN THE SUPREME COURT OF NORTH CAROLINA
Filed 12 February 1993
333 N.C. 258 (1993)
MITCHELL, Justice.
1. Master and Servant § 69 (NCI3d) — workers’ compensation — components of award
There are two distinct components of an award under the Workers’ Compensation Act: (1) payment for the cost of medical care, now denominated “medical compensation,” which consists of the employee‘s medical expenses incurred as a result of a job-related injury; and (2) general “compensation” for financial loss other than medical expenses, which includes payment to compensate for an employee‘s lost earning capacity and payment of funeral expenses.
Am Jur 2d, Workers’ Compensation §§ 379, 435.
2. Master and Servant § 75 (NCI3d) — workers’ compensation — future medical expenses — change of condition not required
While
Am Jur 2d, Workers’ Compensation § 435.
Justice MEYER dissenting.
Justices WEBB and PARKER did not participate in the consideration or decision of this case.
On discretionary review of an unpublished decision of the Court of Appeals, 105 N.C. App. 443, 413 S.E.2d 801 (1991), reversing a decision of the Industrial Commission, entered 31 August 1990, which denied the plaintiff‘s request under
Tuggle, Duggins & Meschan, P.A., by Joseph Brotherton and J. Reed Johnston, Jr., for the defendant-appellants.
Kathleen Shannon Glancy, for the North Carolina Academy of Trial Lawyers, amicus curiae.
MITCHELL, Justice.
Certain facts are uncontroverted in this worker‘s compensation action. The plaintiff, Hassell Hyler, suffered a compensable injury to his left knee on 2 January 1980, while employed by the defendant, GTE Products. The plaintiff underwent six knee surgeries between January of 1980 and June of 1983; in the June 1983 surgery, the plaintiff‘s knee joint was replaced. By 24 May 1984, the plaintiff‘s knee had reached its maximum medical improvement, but he was left with permanent partial disability of his left leg.
The parties agree that there is a substantial risk that the plaintiff‘s prosthetic knee will fail and that the knee replacement surgery will have to be performed again. Because of this risk, the plaintiff must be seen at least annually by his orthopedist in order to monitor the condition of his knee. The condition of the plaintiff‘s knee has not materially deteriorated since June 1984.
On 14 February 1985, the Industrial Commission approved the parties’ final agreement entered on Commission Form 26 in which the defendants agreed to pay compensation to the plaintiff for the permanent partial disability of his left leg. This form agreement contained no provision concerning the plaintiff‘s medical expenses related to his compensable injury. The plaintiff was last paid compensation by the defendants on 25 February 1985. On 19 February 1986, the plaintiff sought to reopen his claim before the Industrial Commission, asking for additional compensation for his disability based on the grounds of a change of condition as provided in
The plaintiff appealed to the Court of Appeals, which reversed the Commission‘s order after concluding, in an unpublished opinion, that the defendants must pay for the plaintiff‘s “future medical expenses which his artificial knee will assuredly require.” The defendants’ petition for discretionary review of the decision of the Court of Appeals was allowed by this Court on 24 June 1992.
Because we conclude that the “change of condition” requirement of
Relevant portions of the version of
Medical, surgical, hospital, nursing services, medicines, sick travel, rehabilitation services, and other treatment including medical and surgical supplies as may reasonably be required to effect a cure or give relief and for such additional time as in the judgment of the Commission will tend to lessen the period of disability, and in addition thereto such original artificial members as may be reasonably necessary at the end of the healing period shall be provided by the employer. In
case of a controversy arising between the employer and employee relative to the continuance of medical, surgical, hospital, or other treatment, the Industrial Commission may order such further treatments as may in the discretion of the Commission be necessary.
The Commission may at any time upon the request of an employee order a change of treatment and designate other treatment suggested by the injured employee subject to the approval of the Commission, and in such a case the expense thereof shall be borne by the employer upon the same terms and conditions as hereinbefore provided in this section for medical and surgical treatment and attendance.
In Little v. Penn Ventilator Co., 317 N.C. 206, 211, 345 S.E.2d 204, 208 (1986), we stated that the legislature intended
The dissent argues that this Court in Little announced a “change in law.” To the contrary, this Court in Little merely interpreted the version of
In the present case, the defendants concede that there is a substantial risk that the plaintiff‘s prosthetic knee will fail and will have to be replaced and that the plaintiff‘s condition must be monitored regularly by a physician for this reason. All parties agree that the plaintiff‘s condition has not materially changed since the Industrial Commission approved the parties’ last Form 26 agreement on 14 February 1985 and, thereby, entered its award. The defendants argue that, despite the fact that he otherwise might be entitled under
In determining the meaning of statutes, we follow the traditional rules of statutory construction.
Legislative intent controls the meaning of a statute; and in ascertaining this intent, a court must consider the act as a whole, weighing the language of the statute, its spirit, and that which the statute seeks to accomplish. The statute‘s words should be given their natural and ordinary meaning unless the context requires them to be construed differently.
Shelton v. Morehead Memorial Hospital, 318 N.C. 76, 82, 347 S.E.2d 824, 828 (1986) (citations omitted), quoted in Evans v. AT&T Technologies, 332 N.C. 78, 86, 418 S.E.2d 503, 508-09 (1992). “Statutory interpretation properly begins with an examination of the plain words of the statute.” Correll v. Division of Social Services, 332 N.C. 141, 144, 418 S.E.2d 232, 235 (1992) (citing Electric Supply Co. v. Swain Elec. Co., 328 N.C. 651, 656, 403 S.E.2d 291, 294 (1991)). If the language of the statute is clear and is not ambiguous, we must conclude that the legislature intended the statute to be implemented according to the plain meaning of its terms. Id. (citing Lemons v. Boy Scouts of America, Inc., 322 N.C. 271, 276, 367 S.E.2d 655, 688, reh‘g denied, 322 N.C. 610, 370 S.E.2d 247 (1988)).
Nothing in the language of
Upon . . . the application of any party in interest on the grounds of a change in condition, the Industrial Commission may review any award, and on such review may make an award ending, diminishing, or increasing the compensation previously awarded, subject to the maximum or minimum provided in this Article . . . . No such review shall affect such award as regards any moneys paid but no such review shall be made after two years from the date of the last payment of compensation pursuant to an award under this Article, except that in cases in which only medical or other treatment bills are paid, no such review shall be made after 12 months
from the date of the last payment of bills for medical or other treatment, paid pursuant to this Article.
This statute applies only to reviews of previously entered awards and provides that “on such review [the Commission] may make an award ending, diminishing, or increasing the compensation previously awarded.”
In many jurisdictions the payment of medical expenses is held to be tantamount to the payment of compensation. However, under the definition of the word “compensation” contained in . . . [
N.C.G.S. § 97-2(11) ], payment of medical or hospital expenses constitutes no part of compensation under the provisions of our Workmen‘s Compensation Act. Morris v. Chevrolet Co., 217 N.C. 428, 8 S.E. (2d), 484. Compensation is defined in our statute as the money allowance payable to an employee or his dependents, including funeral benefits.
Whitted v. Palmer-Bee Co., 228 N.C. 447, 453, 46 S.E.2d 109, 113 (1948); but cf. Biddix v. Rex Mills, 237 N.C. 660, 666, 75 S.E.2d 777, 782 (1953) (quoting with approval an opinion of an Industrial Commissioner which erroneously implied that the payment of medical bills was compensation).
The legislature‘s 1991 amendments to
The dissent would include medical payments provided under
consistently given to the statute is as much a part of the statute as if expressly written in it. We have no right to change or ignore it. If it is to be changed, it must be done by the Legislature, the law-making power. If, in its wisdom, a change is desirable, it can readily do so.
Hensley v. Cooperative, 246 N.C. 274, 281, 98 S.E.2d 289, 294 (1957), quoted in O‘Mary v. Clearing Corp., 261 N.C. 508, 511, 135 S.E.2d 193, 195 (1964). In our interpretation of the meaning of “compensation” under the Workers’ Compensation Act, we adhere to the time-honored doctrine of stare decisis, and we decline to take the contrary position set out by the dissent.
We acknowledge that the terms of
[2] Bearing in mind the well-established definition of “compensation” within the Workers’ Compensation Act and the legislative intent that provisions of the Act be interpreted liberally in favor of an employee-claimant, we conclude that
The dissent‘s reliance on the portion of
In sum, we conclude that the legislature always has provided for, and continues to provide for, two distinct components of an award under the Workers’ Compensation Act: (1) payment for the cost of medical care, now denominated “medical compensation,” which consists of payment of the employee‘s medical expenses incurred as a result of a job-related injury; and (2) general “compensation” for financial loss other than medical expenses, which includes payment to compensate for an employee‘s lost earning capacity and payment of funeral expenses. While
This interpretation of
Affirmed.
Justices WEBB and PARKER did not participate in the consideration or decision of this case.
The claimant was injured on 2 January 1980. The parties entered into a Form 21 Agreement (Agreement for Compensation for Disability), which was approved by the Industrial Commission on 27 February 1980. The Form 21 Agreement and two Form 26 Agreements (Supplemental Memorandum of Agreement as to Payment of Compensation), both of which were approved by the Commission, became the final decision of the Commission. Pruitt v. Knight Publishing Co., 289 N.C. 254, 221 S.E.2d 355 (1976) (upon approval by the Industrial Commission, Forms 21 and 26 have the full force and effect of a final award by the Commission). The claimant was paid all benefits for temporary-total disability and for permanent-partial disability (50% of the left leg) and all medical expenses due him under the law. The claimant‘s last check for compensation was forwarded to him on 25 February 1985. A Form 28B dated two days later, 27 February 1985, summarizing benefits paid, was issued by the employer and contained the form language “that upon receipt of this form your compensation stops. If you claim further benefits, you must notify the Commission in writing within two (2) years from the date of the receipt of your last compensation check.” The Form 28B was on file with the Commission, was considered by the Commission in its determination of the claim, and there is no suggestion in the record that Mr. Hyler, who was represented throughout by counsel, did not receive this form.
There was nothing unusual about the case up to this point, as everything was handled in strict compliance with the procedures and forms properly prescribed by the Commission. The claimant received everything he was entitled to under the law as it was then understood to be. The overwhelming majority of workers’ compensation claims are resolved consensually in exactly the same manner as this case was originally resolved — compensability is admitted; medical expenses are paid; the injured claimant is compensated for temporary-total and permanent-partial disability pursuant to Form 21 and Form 26 Agreements; and subject to a change in condition, this resolution of the claim is approved by the Commission and becomes final, a Form 28 is filed, and the claim is closed.
On 19 February 1986, the claimant, through counsel, made an application for additional compensation based upon a claimed change in condition, which, by stipulation of the parties, cannot be shown.
After the final determination of the claimant‘s workers’ compensation claim, and after the last payment of compensation to the claimant, this Court rendered its decision in Little v. Penn Ventilator Co., 317 N.C. 206, 345 S.E.2d 204 (filed 2 July 1986), allowing the recovery of future medical expenses in the original award of the full Commission. Thus, pursuant to Little, the precise relief sought in this case may now be awarded in all cases in the Commission‘s original determination of the claim.
Some eight months following our decision in Little, by letters dated 10 March 1987 and 15 July 1987, the claimant expanded his application to include a request for additional medical benefits as well as compensation, thus seeking to take advantage of the change in the law announced in this Court‘s decision in Little, and thereby to obtain an award of future medical expenses.
The matter of the claimant‘s entitlement to additional benefits for a change of condition and future medical expenses came on for hearing on 9 January 1989. The parties stipulated and agreed that the claimant could produce no evidence of a change in condition. On 16 August 1989, the Deputy Commissioner‘s opinion and award was filed. The Deputy Commissioner concluded (1) that the claimant had not sustained a material change for the worse in his condition, and (2) that the claimant was entitled to future medical expenses for treatment to the extent that such treatment tended to effect a cure of, give relief from, or lessen his disability from the compensable knee injury.
The opinion for the full Commission was filed on 31 August 1990. The full Commission
On appeal, the Court of Appeals first found that the full Commission had correctly interpreted and applied the Workers’ Compensation Act when it held that the claimant‘s claim for future medical expenses was barred by
This Court in Hogan v. Cone Mills Corp., 315 N.C. 127, 337 S.E.2d 477 (1985), expressly and unequivocally held that the Industrial Commission was without power to reopen an otherwise final decision solely because of subsequent developments in the law.
I believe that the majority grievously errs in holding that
The Court of Appeals, in Shuler v. Talon Div. of Textron, 30 N.C. App. 570, 227 S.E.2d 627 (1976), was presented with a claim for future medical expenses, which claim was made after the filing of Form 28B and the last payment of compensation. The Court of Appeals in Shuler correctly and squarely held that
Therefore claimant‘s procedure was inextricably tied to G.S. 97-47, which requires notice within twelve months of the last payment of compensation and a showing of change of condition. Where an award directs the payment of both compensation and medical expenses, then the injured employee has one year (two years effective 1 July 1974, G.S. 97-47 as amended) from the last payment of compensation pursuant to the award in which to file claim for further compensation
upon an alleged change of condition. Where the award directs the payment of medical bills only, an extension of the award would not be permissible unless there is a showing of change of condition since the original award. If the legislature had intended that no showing of a change of condition was necessary where only additional medical expense payments are sought, it would have so provided.
Id. at 576-77, 227 S.E.2d at 631 (emphasis added) (citation omitted). The majority, without any analysis or discussion of Shuler, overrules it.
In the case sub judice, the claimant has stipulated that he cannot show a change in condition. Hence, he clearly is statutorily barred from reopening this claim for an award of future medical expenses.
Upon . . . the application of any party in interest on the grounds of a change in condition, the Industrial Commission may review any award, and on such review may make an award ending, diminishing, or increasing the compensation previously awarded, subject to the maximum or minimum provided in this Article . . . . No such review shall affect such award as regards any moneys paid but no such review shall be made after two years from the date of the last payment of compensation pursuant to an award under this Article, except that in cases in which only medical or other treatment bills are paid, no such review shall be made after 12 months from the date of the last payment of bills for medical or other treatment, paid pursuant to this Article.
Many, if not most, workers’ compensation claims are closed by a final award of medical expenses only.
The underlined words relating to medical expenses are meaningless if, as the majority has ruled, the Commission is limited to “ending, diminishing, or increasing the compensation previously awarded” (emphasis added), if compensation does not include medical and treatment expenses. If the Commission may end, diminish, or increase only “compensation” for lost wages and earning capacity, there would be no need to limit the time for review of “bills for medical or other treatment, paid pursuant to this Article.”
I fail to see how the majority can conclude that the legislature did not intend for an injured employee to make any showing of a change in condition before his employer would be required to pay for further medical services or treatment. If that conclusion were correct, what possible meaning would one attribute to the underlined words limiting the time for review of a previous award that related only to medical and treatment expenses?
The majority complains that reliance in this dissent on the language of
It is important to note that the effect of the majority opinion is not only to no longer require a showing of a change of condition, but also to do away with any statutory time limitation, after a final award of medical benefits only, to file for additional benefits for “medical, surgical, hospital, nursing, and rehabilitation services, and medicines, sick travel, and other treatment, including medical and surgical supplies, as may reasonably be required to effect a cure or give relief” (now defined as “medical compensation“).
If the legislature had intended that there should be no time limitations for reopening claims to recover additional medical expenses (now defined as “medical compensation“), it would not have provided that employers may destroy records of claims five years after a claim is closed by an award.
The majority implies that its decision in this case does not constitute a change in existing law. Nothing could be further from the truth. Employees, employers, and the Commission have heretofore constantly observed the change of condition and time limitations requirements of
I make no personal judgment as to the overall desirability of the change. I do, however, recognize that the majority has wrought a major change, and I strenuously object to that change being made in an already precariously balanced compensation system by this Court rather than by
Changes of this magnitude in our state‘s workers’ compensation plan require public policy considerations that fall within the exclusive province of the legislature, and rightly so. When this Court makes such a drastic change in long-settled workers’ compensation law, it does so with little or no information upon which to weigh the fallout of the change. When it is done by the legislature, there is discussion and debate and input from interested and informed parties, and benefits and detriments of the change may be weighed. Legislative changes of this magnitude are ordinarily made effective prospectively only,
adjusted. If the legislature makes such a change, these problems are unlikely to arise.
Because of tough policy decisions made by our legislature through the years, North Carolina has traditionally been more conservative in the benefits provided and has had among the lowest workers’ compensation premiums in the nation. While this is but one of many factors that influence industries and businesses that are considering locating or relocating facilities with significant employment opportunities, it is an important one and one that has been and continues to be influential in our ability to attract new industry and to diversify our economy. The need to create new jobs and attract new industry can hardly be overstated in these difficult economic times. This consideration obviously comes to the forefront as premiums rise more rapidly in this state than in our sister adjoining states.
In August 1991, the North Carolina Rate Bureau requested a 41.8% rate increase, the Commissioner of Insurance approved a 15.8% increase, and the Rate Bureau and the Commissioner settled at that figure. A year later, in October 1992, the Rate Bureau requested a 58.4% increase; the Commissioner approved a 23.4% increase; and, after the Rate Bureau and the Commissioner failed to agree on the increase, the Rate Bureau implemented a 40.3% increase subject to refund. The requested increase for 1992 in the surcharge for the Workers’ Compensation Assigned Risk Pool for high risk employers who cannot purchase coverage on the market was 20%, the Commissioner has approved a 14% increase for 1993, and the increase was settled at that figure. There exists a real threat that if the companies currently writing workers’ compensation insurance do not receive significant rate relief, a number of them will stop writing coverage in North Carolina. That this is a real possibility and not an idle threat is evidenced by the fact that the nation‘s largest workers’ compensation carrier, Liberty Mutual, served notice in December 1991 that in December 1992, it would no longer write new workers’ compensation policies in seventeen states, including North Carolina.
The impact of the aforementioned decisions which have drastically changed the
In summary, at no time has the claimant attacked the propriety of the Form 21 and Form 26 Agreements as of the time they were entered and approved. There is no claim of fraud, mistake, overreaching, or even inadvertence with respect to these agreements. As stipulated by the parties, all of the facts now asserted in support of the claimed entitlement of an award of future medical benefits were fully known to the parties prior to the 1 November 1984 date of the second Form 26 and well before the date of the last payment of compensation on 25 February 1985. By virtue of the Form 21 and Form 26 Agreements, the claimant was provided with all benefits to which he was entitled under the law as it was then understood to be.
The majority opinion will potentially permit the reopening of a vast and indeterminate number of final awards of the Industrial Commission. What is at stake here is the concept of finality that is essential to the proper, economical, and efficient operation of administrative, quasi-judicial, and judicial bodies. If the final determinations of such bodies can be reopened without any time limitation whatsoever, nothing would ever be decided. A strong adherence to the doctrine of finality is as essential to the sound economical and efficient operation of the Industrial Commission as it is to the operation of the courts. It is essential to the effective operation of the whole workers’ compensation system that consensual resolutions of cases such as the one here be encouraged. A holding depriving such agreements of finality can only do great harm to the efficient functioning of the Industrial Commission and to the operation of the entire workers’ compensation system.
In view of the drastic changes wrought by this and other cases cited herein, perhaps it is time for the legislature to review and reassess the delicate balance of interests between employee and employer under our Workers’ Compensation Act.
Notes
Medical, surgical, hospital, nursing services, medicines, sick travel, rehabilitation services, and other treatment including medical and surgical supplies as may reasonably be required to effect a cure or give relief and for such additional time as in the judgment of the Commission will tend to lessen the period of disability, and in addition thereto such original artificial members as may be reasonably necessary at the end of the healing period. . . .1991 N.C. Sess. Laws ch. 703, § 3. The legislature also added subsection (19) to
Medical Compensation. — The term ‘medical compensation’ means medical, surgical, hospital, nursing, and rehabilitative services, and medicines, sick travel, and other treatment, including medical and surgical supplies, as may reasonably be required to effect a cure or give relief and for such additional time as, in the judgment of the Commission, will tend to lessen the period of disability; and any original artificial members as may be reasonably necessary at the end of the healing period.1991 N.C. Sess. Laws ch. 703, § 1.