How To Handle Hyler Claims

In the wake of Hyler v. GTE Products Co., how do you bring a claim of future medical expenses on behalf of an injured worker? What factors mean the difference between success and failure?

One clear lesson of Hyler is that valid claims for continuing expenses may be lurking in workers’ compensation cases that have been closed for years.

Lawyers Weekly contacted workers’ compensation experts, attorneys in the case and N.C. Industrial Commissioner J. Randolph Ward, who wrote the initial order in Hyler. They offered the following practice pointers:

Determine if the Industrial Commission case has been closed. If the claim was heard by the full commission, was an Opinion and Award of benefits issued? If so, future medical expenses are likely covered. But Raleigh lawyer James T. Lore says only around two percent of all claims result in Opinion and Awards. The vast majority are concluded by ‘clincher’ settlements or Form 26 agreements.

Check to see if a Form 26 agreement was filed. Hyler involved a standard Form 26 agreement that made no mention of future medical expenses. The court said they were recoverable anyway.

Don’t get tripped by the two-year trap. G.S. § 97-47 says workers have two years from the date of a final comp award to ask the Industrial Commission to reconsider the case. But in Hyler, the court said this limitation did not apply to claims for medical payments.

Don’t worry if your client’s medical condition has not changed since the final comp award. A key holding in Hyler was that no ‘change of condition’ showing is required to press a claim for continuing medical expenses.

Be on the lookout for open-ended reserves. In his dissent, Justice Louis B. Meyer said requiring indefinite payment of medical expenses could have disastrous consequences for employers and their comp carriers. He said carriers will not know how much money to set aside for claims, and predicted future cases will require ‘open-ended reserves.’

Beware of pending legislative changes. The General Assembly may well have the final say on who must pay continuing medical expenses. ‘In a way it comes down to competing philosophies,’ said Commissioner Ward. ‘The majority in Hyler emphasized the remedial nature of the [Worker’s Compensation] Act. They cite the often-quoted language that the act should be interpreted ‘to compel industry to take care of its own wreckage.’ In his dissent, Justice Meyer talked about the other side, about the precarious balance of interests in the system. The final word may have to come from the legislature.’