The Court of Appeals released two opinions this week on workers’ compensation. In the first opinion, Fonville v. General Motors, the most significant holding concerned the defendants’ unilateral termination of benefits. In this case, the plaintiff was hurt when she was struck in the head by a tent pole at a corporate event, and the defendants accepted her workers’ comp claim by filing a Form 60. The plaintiff appeared to have fully recovered several months later, by which time she had already been terminated for a reason unrelated to her injury. At this point, the defendants terminated her benefits, without filing any form with the Industrial Commission or asking for a hearing.
While the Commission denied the plaintiff’s claim for benefits for the period up until she found another job, the Court of Appeals unanimously reversed. The court held that defendants can only terminate benefits for an accepted claim if (1) the plaintiff has returned to work, (2) defendants ask for a hearing, or (3) defendants comply with N.C.G.S. 97-18(c) and I.C. Rule 404 by filing a Form 24. As defendnats did not file a Form 24 or ask for a hearing before terminating benefits, they denied the plaintiff due process. Therefore, plaintiff is now entitled to the benefits up until the time she returned to work, plus the 10% penalty under N.C.G.S. 97-18(g). The remainder of the Commission’s decision, in part concluding that the plaintiff was not entitled to further medical treatment, was affirmed. This decision forcefully reminds employers and their insurance companies that they have to follow the rules. Cutting off someone’s benefits is a significant matter, and workers need due process so that they can contest unlawful decisions.
The second opinion, Dobson v. The Salvation Army, is unpublished, and generally consists of the court affirming the decision of the Industrial Commission because the Commission’s findings were supported by at least some competent evidence. Of note is how one of plaintiff’s experts was handled, and whether she was qualified to give expert medical testimony. The expert testified to the plaintiff’s depression and substance abuse issues, whether those were caused or aggravated by the plaintiff’s injury, and how they affected his ability to work. At the deposition, defendants’ counsel stipulated that the witness was an expert in social work and substance abuse. Then, defendants did not raise the issue of her qualifications before the Full Commission. Thus, the court held that defendants had waived the issue, and could no longer challenge her. So, it’s important to remember the usual rules about appeals and waivers, even when practicing in the Commission.