North Carolina Appellate Court Reverses Award of Benefits Based on Commission’s Improper Application of Presumption in Favor of Finding Causal Link between the Accident and Plaintiff’s Additional Injuries

When an employee is hurt at work, the workers’ compensation system may provide him or her with benefit payments to replace weekly wages as well as reimbursement for medical expenses. Understanding the claims process can be very stressful, especially if this is your first encounter with seeking benefits. The dedicated North Carolina work injury lawyers at Maurer Law are prepared to help you ensure that you protect your legal rights to the fullest extent.

In a recent claim, the plaintiff worked in a major department store for nearly 22 years when she tripped and fell forward over the bottom of a stairway ladder. She attempted to break her fall and struck her wrist on the cement floor as well as her shoulder and knee. The plaintiff received emergency medical treatment for her injuries and she was diagnosed with a shoulder sprain. She followed up with the doctor several times complaining of continued pain in her wrist, shoulder, arm, neck, and knee. She underwent many additional medical examinations and treatments to address her pain and symptoms.

The plaintiff filed a claim for workers’ compensation benefits and the employer accepted plaintiff’s claim and identified the injury as impacting her right shoulder and arm. The insurer later filed a form indicating that it denied compensability of any new injuries that the plaintiff reported outside of her employment involving her cervical spine. The matter came before a Deputy Commissioner for hearing and he concluded that the plaintiff had suffered a work-related injury that impacted her wrist, knee, and pre-existing cervical disc disease. The plaintiff was awarded benefits and compensation for her medical expenses, including any surgical procedures that were recommended.

The defendant appealed and the reviewing commission concluded that because the defendant filed a form accepting compensability of her injuries, a presumption arose that the plaintiff’s other injuries were related to her accident and that the insurer was required to rebut that presumption with evidence. The defendant appealed again, and the Court of Appeals concluded that the lower court erred in applying the presumption, but found sufficient evidence in the record to also conclude that the plaintiff had established a causal link between all of her injuries and the accident.

On appeal to the Supreme Court of North Carolina, the high court first noted that the insurer listed only right shoulder and arm injuries in the form accepting compensability of the plaintiff’s injuries. Turning to the Commission’s findings, the Supreme Court found an inconsistency regarding whether the Commission relied on this presumption or independent evidence establishing causation to conclude that the insurer must pay benefits for all of the plaintiff’s injuries. The Supreme Court was unable to determine whether the Commission and the Court of Appeals found sufficient evidence to link the additional injuries concerning the plaintiff’s neck and other ailments to the fall and whether the Commission placed the burden of proof or need to rebut causation on the insurer. As a result, the Supreme Court remanded the case for further proceedings on the issue of causation.

If you were hurt at work, you deserve knowledgeable and efficient legal counsel to help you determine whether you are entitled to workers’ compensation benefits. There are countless procedural and substantive rules that claimants must follow, or they risk losing their right to payments. We have handled countless different types of work injuries and offer a free consultation to discuss your situation and to help you understand how we can assist you. Call us now at 1-888-258-1087 or contact us online to set up your appointment.

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