KEY TAKEAWAYS:

• North Carolina’s Supreme Court has revisited the issue of medical treatment in the context of workers’ compensation

• In doing so, it reversed a Court of Appeals decision and remanded the case to the Industrial Commission for further proceedings, emphasizing the importance of applying the correct legal standard

• The North Carolina Supreme Court ruling has provided clarity and guidance for future cases in this complex area of law

It is well established that under the North Carolina workers’ compensation law, the question of whether a specific medical treatment is compensable or not hinges largely on the causal relationship between the treatment sought and the workplace injury. This principle, deeply ingrained in North Carolina’s workers’ compensation statutes, ensures that compensation remains focused on injuries directly related to the workplace, rather than morphing into a general health insurance policy for employees.

In a recent case, Kluttz-Ellison v. Noah’s Playloft Preschool, the North Carolina Supreme Court revisited the issue of compensable medical treatment in the context of workers’ compensation. The case involved a worker who sought compensation for bariatric weight loss surgery, which the worker’s authorized treating physician opined was the fastest way to help the worker lose the amount of weight required for her to qualify for the knee surgery deemed necessary to treat her workplace injury. As such, the worker argued that the bariatric weight loss surgery itself should be deemed a compensable medical treatment.

In analyzing the facts of the Kluttz-Ellison case, the North Carolina Supreme Court emphasized the necessity of a strong causal relationship between the condition necessitating treatment and the workplace injury. Citing longstanding appellate court precedents, the court endorsed the “directly related” test, which scrutinizes whether the treatment sought is directly tied to the workplace injury. This test, developed over years of judicial interpretation, ensures that workers’ compensation remains true to its intended purpose of compensating injuries sustained specifically in the workplace.

In the Kluttz-Ellison case, both the deputy commissioner and the NC Appellate Court failed to properly apply this legal standard. Instead of focusing on the causal connection between the plaintiff’s body weight issues (the condition) and the workplace injury, the lower courts concentrated solely on the necessity of the bariatric weight loss treatment itself to “affect a cure or lessen the period of disability.” As a result, the North Carolina Supreme Court reversed the decision of the Court of Appeals and remanded the case to the Industrial Commission for further proceedings, emphasizing the importance of applying the correct legal standard.

The Kluttz-Ellison case underscores the critical importance of causality in determining compensable medical treatment under the North Carolina workers’ compensation law. By reaffirming the “directly related” test and emphasizing the need for a robust causal connection between the condition necessitating the requested treatment and the workplace injury, the North Carolina Supreme Court has provided clarity and guidance for future cases in this complex area of law.

If you have questions about how this impacts your business, please contact:

• Evan B. King
• Gregory S. Horner
• Erica B. Lewis
• Damon M. Gruber
• Sean J. McKinley
• Esther F. Omoloyin
• Or another member of our Workers’ Compensation practice group