Workers’ Compensation – Causation – Parsons Presumption – Anxiety – Disability – Russell Inapplicable – Tinnitus

Wilkes v. City of Greenville (Lawyers Weekly No. 010-036-17, 28 pp.) (Robin Hudson, J.) Appealed from the Industrial Commission. On discretionary review from the Court of Appeals. N.C. S. Ct.

Holding: As our Court of Appeals held in Parsons v. Pantry, Inc., once it has been determined that a workers’ compensation plaintiff’s injury is compensable, he need not re-prove causation each time he seeks treatment for that injury.

We affirm the Court of Appeals’ decision to vacate and remand so that the Industrial Commission could give plaintiff the benefit of a presumption that his anxiety and depression were related to his compensable injuries. We modify and affirm the Court of Appeals’ decision as to disability.

As a result of a motor vehicle crash that occurred within the course and scope of his employment, plaintiff sustained injuries that included an abrasion on his head, three broken ribs, and injuries to his neck, back, pelvis, hip, and entire left side, as well as a concussion. Defendant filed a Form 60 accepting that plaintiff had suffered compensable injuries by accident and began paying temporary total compensation and medical compensation for plaintiff’s injuries.

Plaintiff subsequently sought additional medical treatment for tinnitus, anxiety, and depression, alleging that these conditions were directly related to his compensable injuries. The Commission concluded that plaintiff had failed to prove a causal relationship between these conditions and the accident.

Plaintiff also sought continuing disability benefits. The Commission rejected this claim as well.

The Court of Appeals overturned the Commission’s decision as to both issues.

Causation

The question here concerns whether, when an injury has previously been established as compensable, a presumption arises that additional medical treatment is related to the compensable injury. While we have yet to address whether a presumption arises in the context of medical compensation, the Court of Appeals first addressed this issue in Parsons v. Pantry, Inc., 126 N.C. App. 540, 485 S.E.2d 867 (1997).

In that case, the Court of Appeals held that, once the plaintiff had met her burden of proving causation, she was not required to re-prove causation each time she sought treatment for the very injury that the Commission had previously determined to be the result of her compensable accident. The Parsons presumption is that additional medical treatment is directly related to the compensable injury. The Court of Appeals later held that the Parsons presumption applies both to agreements to pay compensation by means of a Form 21 and to cases involving direct payment accompanied by a Form 60.

We hold that plaintiff here is entitled to a presumption that additional medical treatment is related to his compensable conditions. An admission of compensability approved under G.S. § 97-82(b) entitles an employee to a presumption that additional medical treatment is causally related to his compensable injury. In reaching this conclusion, we note the mandatory language of G.S. § 97-25(a) (stating that “[m]edical compensation shall be provided by the employer”), as well as the fact that medical compensation encompasses any treatment that “may reasonably be required to effect a cure or give relief,” G.S. § 97-2(19).

Requiring the employee to repeatedly build claims for medical compensation for an admittedly compensable injury, as argued by defendant, would be inconsistent with the language of §§ 97-25, 97-2(19), and 97-82(b), as well as the purpose and spirit of the Workers’ Compensation Act. We decline to adopt such a narrow interpretation of the Act.

We affirm the Court of Appeals’ holding that plaintiff was entitled to a presumption that his anxiety and depression were causally related to his compensable injuries.

Disability

In Russell v. Lowes Product Distribution, 108 N.C. App. 762, 425 S.E.2d 454 (1993), the Court of Appeals provided examples of methods by which a plaintiff could prove disability. This court has not adopted Russell; the approaches taken therein are not the only means of proving disability.

Here, plaintiff has numerous preexisting limitations as found by the Commission (over the age of 60, limited IQ of 65, limited education and work experience), so Russell is inapposite. In determining loss of wage-earning capacity, the Commission must take into account age, education, and prior work experience as well as other preexisting and coexisting conditions.

If plaintiff shows total incapacity for work, taking into account his work-related conditions combined with these other factors, he is not required to also show that a job search would be futile.

We remand to the Commission to make specific findings addressing plaintiff’s wage-earning capacity, considering plaintiff’s compensable tinnitus in the context of all the preexisting and coexisting conditions bearing upon his wage-earning capacity.

Affirmed in part, modified and affirmed in part, and remanded.