The Tale of Multiple Body Parts
When a workers’ compensation injury occurs in North Carolina, the insurer either accepts or denies the claim. When the claim is accepted, the injured worker gets medical treatment for that body part, plus disability benefits if appropriate. But in the real world, accidents often cause workers to injure many different body parts, not just one. We at Ricci Law Firm routinely help clients who have hurt several body parts during the same accident…back and leg, neck and shoulder, wrist and fingers, you get the gist. So what happens when the insurer only “accepts” one body part, even though another body part also needs fixing?
This question turns out to be complicated, and Ricci Law Firm is closely watching legal developments to protect the rights of its clients. Back in 2015, in a case called Wilkes, the North Carolina held that when the insurer admits that a worker injured a certain body part in an accident, the worker gets a presumption that other body parts and medical conditions are also covered. Kind of a buy-one-get-one-free kind of deal. The Wilkes case would have been very helpful for injured workers, except that, very shortly after that case was published, the North Carolina legislature changed the law so that the injured worker must bear the burden of proving the second body part is related to the accident. In real life, this new law means that even if common sense tells us the injury is due to the accident, the worker (through his or her attorney) still must go out and find and pay for a separate medical evaluation or opinion. This process takes time and money, but more importantly, gives the insurer an excuse to deny the body part.
But doesn’t that new law sound unfair? Some workers’ compensation attorneys, including those at the Ricci Law Firm, believe the new law may be unconstitutional under the 14th Amendment right to due process. The legal community has been waiting eagerly to see how North Carolina’s appeals courts would deal with this new law – will they uphold it or find it to be unconstitutional?
Finally, this week, in Pine v. Wal-Mart (7 Dec 2018), the North Carolina Supreme Court published an opinion that gets us closer to an answer. The Supreme Court found that the Industrial Commission award had not set out clearly enough which party has the burden of proof under the new law, so the Court sent the case back to the Industrial Commission to clarify. The most important part of the 16-page opinion of Pine v. Wal-Mart is a tiny footnote indicating that the injured worker may challenge the constitutionality of the new law in the future, if she so chooses.
The lesson here? The fight is not over. Until the Supreme Court states otherwise, attorneys for injured workers in North Carolina will continue to argue that the law is unconstitutional and that all body parts should be presumed to be related to the work injury. The workers’ compensation team at Ricci Law Firm regularly monitors the state of the law and will keep you informed as this issue continues to develop.