Doctor's incorrect assumption about back problems derails causation

In North Carolina, in the absence of an admission of compensability by the employer or an agreement between the parties, there is no presumption that additional medical treatment is causally related to the original injury.

Case name: Gross v. Gene Bennett Co., No. COA10-29 (N.C. Ct. App. 01/18/11).

Ruling: The North Carolina Court of Appeals held that a worker was not entitled to compensation for his disk herniation injury because he failed to establish that it was caused by his prior work-related injury.

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What it means: In North Carolina, in the absence of an admission of compensability by the employer or an agreement between the parties, there is no presumption that additional medical treatment is causally related to the original injury.

Summary: A machinist was working when he fell through an 8-foot ceiling, falling 10 feet before hitting a concrete floor. His employer accepted his workers' compensation claim on a medicals-only basis. The machinist's doctor released him to return to full duty. The machinist sought further treatment from an orthopedic surgeon. Two MRIs revealed degenerative disk disease and a disk extrusion or herniation. The machinist sought compensation for his low back condition. The North Carolina Court of Appeals held that the machinist was not entitled to compensation for his disk herniation injury.

The employer argued that there should not have been a presumption that the additional medical treatment was causally related to the original injury. The court agreed, stating that in past cases, the presumption arose because of a prior determination of compensability. In this case, there was no stipulation that the machinist suffered a compensable injury. The parties agreed that the employer accepted the claim on a medicals-only basis, which was not an admission of liability.

There were conflicting medical opinions as to causation. The court said that one doctor's opinion assumed that the machinist had no prior back problems, which was incorrect. The court said the doctor's opinion did not rise above the level of possibility or speculation.

Read more at the WorkersComp Forum homepage.

March 10, 2011

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