The North Carolina Supreme Court recently rendered its unanimous decision in Wilkes v. City of Greenville affirming the Court of Appeals’ significant expansion of the “Parsons presumption,” a North Carolina precedent that posits a relationship between an original work-related injury and additional treatments required. In Wilkes, the claimant was in a work-related motor vehicle accident, suffering injuries to the head, ribs, neck, back, pelvis, and hip. The carrier admitted compensability of the claim on a Form 60, listing the neck, back, and left hip as the compensable body parts. The plaintiff later sought compensation for depression and anxiety, conditions that were not originally admitted as compensable. The Industrial Commission initially denied the plaintiff’s claim for benefits for anxiety and depression, finding that the plaintiff had failed to present sufficient evidence to prove that his anxiety and depression were causally related to the motor vehicle accident. The Court of Appeals reversed this decision, holding that the plaintiff was entitled to a presumption of compensability on his anxiety and depression and that the defendants therefore had the burden of disproving causation. The Supreme Court affirmed this holding and stated in part that “continually placing the burden on an employee to prove that his symptoms are causally related to his admittedly compensable injury before he can receive further medical treatment ignores [a prior admission of compensability].” The Supreme Court downplayed the significance of its decision, emphasizing that the presumption of compensability is rebuttable.
In addition to applying the Parsons presumption to any claimed injury or condition in a compensable claim, regardless of the original injury, the Supreme Court also made significant waves with its discussion of disability. The Court declined to adopt the standard set in Russell v. Lowes Product Distribution as the way a claimant could prove disability. In Russell, the North Carolina Court of Appeals ruled that an employee may meet the burden of proving disability simply by staying “employed” with the employer of injury. Instead, the North Carolina Supreme Court in Wilkes v. City of Greenville opined that Russell only applied when a claimant was medically able to work and possessed no pre-existing limitations that would render him or her unemployable. The Court concluded that Russell was not applicable to the case before it, since the claimant had several pre-existing limitations (e.g., being 65 years-old, with a low IQ, limited education, and minimal work experience). The Supreme Court also eviscerated the Fields v. H.&E Equipment decision from the Court of Appeals, holding that an employee was not required to present expert testimony to prove inability to earn wages.
With this decision, once a carrier has admitted compensability for one condition, a claimant has a presumption that any future treatment sought, for any body part or condition, is related to the original accident, and defendants must disprove causation. To disprove causation, defendants must have a physician testify that it is more likely than not that a condition is unrelated to the original accident. As one might imagine, getting a physician to rule out completely a potential cause is very difficult to do. Essentially, Wilkes allows a claimant to obtain treatment for any potential condition, once a claim has been admitted as compensable for any injury, unless and until defendants disprove causation for the new injury.
The Wilkes opinion means that any time a claim is admitted as compensable, any future body part or condition is presumed to be related, regardless of the original injury. If a claimant suffers a finger laceration and later complains of neck pain, he has a presumption that the neck pain is causally related to the finger laceration accident. The significance of this presumption cannot be understated, and any carrier or TPA would be wise to be much more cautious than ever before in admitting compensability.
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