Summary
In Hyler, the Court distinguished compensation for financial loss from medical expenses stating that the "overall intent of the Workers' Compensation Act [is] to allow recovery by employees for work-related injuries."
Summary of this case from Mcallister v. Wellman, Inc.Opinion
No. 96PA92
Filed 12 February 1993
1. Master and Servant 69 (NCI3d) — workers' compensation — components of award There are two distinct components of an award under the Workers' Compensation Act: (1) payment for the cost of medical care, now denominated "medical compensation," which consists of the employee's medical expenses incurred as a result of a job-related injury; and (2) general "compensation" for financial loss other than medical expenses, which includes payment to compensate for an employee's lost earning capacity and payment of funeral expenses.
Am Jur 2d, Workers' Compensation 379, 435.
2. Master and Servant 75 (NCI3d) — workers' compensation — future medical expenses — change of condition not required While N.C.G.S. 97-47 requires a claimant to show a "change of condition" before the Industrial Commission may amend an order awarding general "compensation," N.C.G.S. 97-25 permits the Industrial Commission to order the employer to pay new or additional medical expenses even if there has been no material change in the employee's condition or in available medical treatment. The opinion of the Court of Appeals holding to the contrary in Shuler v. Talon Div. of Textron, 30 N.C. App. 570, is overruled. Therefore, the Industrial Commission could order the employer to pay plaintiff's future medical expenses incurred as a result of his knee injury even though the Commission had previously approved the parties' final agreement for compensation where the plaintiff underwent a knee replacement and the parties agree that there is a substantial risk that plaintiff's prosthetic knee will fail and will have to be replaced and that plaintiff's condition must be monitored regularly by a physician for this reason.
Am Jur 2d, Workers' Compensation 435.
On discretionary review of an unpublished decision of the Court of Appeals, 105 N.C. App. 443, 413 S.E.2d 801 (1991), reversing a decision of the Industrial Commission, entered 31 August 1990, which denied the plaintiff's request under N.C.G.S. 97-25 for continuing medical expenses. Heard in the Supreme Court on 2 November 1992.
Patterson, Harkavy, Lawrence, Van Noppen Okun, by Henry N. Patterson, Jr., Jonathan R. Harkavy, and Martha A. Geer, for the plaintiff-appellee.
Tuggle, Duggins Meschan, P.A., by Joseph Brotherton and J. Reed Johnston, Jr., for the defendants-appellant.
Kathleen Shannon Glancy, for the North Carolina Academy of Trial Lawyers, amicus curiae.
Justice MEYER dissenting.
Justices WEBB and PARKER did not participate in the consideration or decision of this case.
Certain facts are uncontroverted in this worker's compensation action. The plaintiff, Hassell Hyler, suffered a compensable injury to his left knee on 2 January 1980, while employed by the defendant, GTE Products. The plaintiff underwent six knee surgeries between January of 1980 and June of 1983; in the June 1983 surgery, the plaintiff's knee joint was replaced. By 24 May 1984, the plaintiff's knee had reached its maximum medical improvement, but he was left with permanent partial disability of his left leg.
The parties agree that there is a substantial risk that the plaintiff's prosthetic knee will fail and that the knee replacement surgery will have to be performed again. Because of this risk, the plaintiff must be seen at least annually by his orthopedist in order to monitor the condition of his knee. The condition of the plaintiff's knee has not materially deteriorated since June 1984.
On 14 February 1985, the Industrial Commission approved the parties' final agreement entered on Commission Form 26 in which the defendants agreed to pay compensation to the plaintiff for the permanent partial disability of his left leg. This form agreement contained no provision concerning the plaintiff's medical expenses related to his compensable injury. The plaintiff was last paid compensation by the defendants on 25 February 1985. On 19 February 1986, the plaintiff sought to reopen his claim before the Industrial Commission, asking for additional compensation for his disability based on the grounds of a change of condition as provided in N.C.G.S. 97-47. On 10 March 1987, the plaintiff further requested that the Commission order GTE Products and its insurance carrier, American Motorists Insurance Co., to pay the plaintiff's continuing medical expenses as mandated by N.C.G.S. 97-25. A deputy commissioner entered an award on 16 August 1989 requiring the defendants to pay the plaintiff's continuing medical expenses incurred as a result of his knee injury. On 31 August 1990, the Industrial Commission entered an order reversing the deputy commissioner's award on the ground that N.C.G.S. 97-47 required the plaintiff to demonstrate, as a condition for payment of future medical expenses under N.C.G.S. 97-25, either that his condition had changed for the worse or that evidence bearing on the need for future medical care had developed or had become available following the Commission's approval of the parties' last agreement for compensation.
The plaintiff appealed to the Court of Appeals, which reversed the Commission's order after concluding, in an unpublished opinion, that the defendants must pay for the plaintiff's "future medical expenses which his artificial knee will assuredly require." The defendants' petition for discretionary review of the decision of the Court of Appeals was allowed by this Court on 24 June 1992.
Because we conclude that the "change of condition" requirement of N.C.G.S. 97-47 does not apply to the plaintiff's request for medical expenses under N.C.G.S. 97-25, we also conclude that the defendants were required to provide for those expenses. Therefore, we affirm the holding of the Court of Appeals.
Relevant portions of the version of N.C.G.S. 97-25 applicable at the time the present case arose provide as follows:
Effective 15 June 1991, the General Assembly made certain technical amendments to N.C.G.S. 97-25. 1991 N.C. Sess. Laws ch. 703, 3. Those amendments are discussed at other points in this opinion.
Medical, surgical, hospital, nursing services, medicines, sick travel, rehabilitation services, and other treatment including medical and surgical supplies as may reasonably be required to effect a cure or give relief and for such additional time as in the judgment of the Commission will tend to lessen the period of disability, and in addition thereto such original artificial members as may be reasonably necessary at the end of the healing period shall be provided by the employer. In case of a controversy arising between the employer and employee relative to the continuance of medical, surgical, hospital, or other treatment, the Industrial Commission may order such further treatments as may in the discretion of the Commission be necessary.
The Commission may at any time upon the request of an employee order a change of treatment and designate other treatment suggested by the injured employee subject to the approval of the Commission, and in such a case the expense thereof shall be borne by the employer upon the same terms and conditions as hereinbefore provided in this section for medical and surgical treatment and attendance.
In Little v. Penn Ventilator Co., 317 N.C. 206, 211, 345 S.E.2d 204, 208 (1986), we stated that the legislature intended N.C.G.S. 97-25 to require that employers provide medical treatments which either will lessen an employee's period of disability, will effect a cure, or will give relief. We also determined that where, as in the present case, an injured employee's condition appeared stable but required monitoring to detect and prevent possible deterioration, medical expenses incurred in monitoring the employee's condition would give "relief" of the type that would require his employer to pay those expenses. Id. at 213-214, 345 S.E.2d at 209-10.
The dissent argues that this Court in Little announced a "change in law." To the contrary, this Court in Little merely interpreted the version of N.C.G.S. 97-25 which has been in effect since 1973. Until 1973, treatment to "effect a cure or give relief" was limited to a period of ten weeks following the in jury; any treatment provided beyond the ten-week period was required to "lessen the period of disability." 1931 N.C. Sess. Laws ch. 274, 4. In 1973, the legislature broadened an employee's right to recover under this statute by removing the time limitation on an employee's right to treatments which would "effect a cure or give relief." 1973 N.C. Sess. Laws ch. 520, 1. In Little, this Court simply explained for the first time the obvious effect of the 1973 amendment. The legislature's 1991 amendment of N.C.G.S. 97-25, which merely moved the "effect a cure or give relief" portion of the statute to the definition of "medical compensation" in the new subsection (19) of N.C.G.S. 97-2, indicates that, when this Court rendered the Little opinion in 1986, we correctly interpreted the legislature's intent as expressed in the 1973 amendment of the statute. 1991 N.C. Sess. Laws ch. 703, 1, 3.
In the present case, the defendants concede that there is a substantial risk that the plaintiff's prosthetic knee will fail and will have to be replaced and that the plaintiff's condition must be monitored regularly by a physician for this reason. All parties agree that the plaintiff's condition has not materially changed since the Industrial Commission approved the parties' last Form 26 agreement on 14 February 1985 and, thereby, entered its award. The defendants argue that, despite the fact that he otherwise might be entitled under N.C.G.S. 97-25 to future medical expenses, the plaintiff is not entitled to have the defendants pay such expenses in this instance because N.C.G.S. 97-47 requires him first to show that his condition has changed materially since the entry of the Industrial Commission's award. We do not agree.
In determining the meaning of statutes, we follow the traditional rules of statutory construction.
Legislative intent controls the meaning of a statute; and in ascertaining this intent, a court must consider the act as a whole, weighing the language of the statute, its spirit, and that which the statute seeks to accomplish. The statute's words should be given their natural and ordinary meaning unless the context requires them to he construed differently.
Shelton v. Morehead Memorial Hospital, 318 N.C. 76, 82, 347 S.E.2d 824, 828 (1986) (citations omitted), quoted in Evans v. ATT Technologies, 332 N.C. 78, 86, 418 S.E.2d 503, 508-09 (1992). "Statutory interpretation properly begins with an examination of the plain words of the statute." Correll v. Division of Social Services, 332 N.C. 141, 144, 418 S.E.2d 232, 235 (1992) (citing Electric Supply Co. v. Swain Elec. Co., 328 N.C. 651, 656, 403 S.E.2d 291, 294 (1991)). If the language of the statute is clear and is not ambiguous, we must conclude that the legislature intended the statute to be implemented according to the plain meaning of its terms. Id. (citing Lemons v. Boy Scouts of America, Inc., 322 N.C. 271, 276, 367 S.E.2d 655, 688, reh'g denied, 322 N.C. 610, 370 S.E.2d 247 (1988)).
Nothing in the language of N.C.G.S. 97-25 implies that the "change of condition" requirement of N.C.G.S. 97-47 applies to any request by an employee for the payment of his medical expenses by his employer. To the contrary, since 1931, N.C.G.S. 97-25 has mandated that an injured employee's medical care "shall be provided by the employer" and that, "[i]n case of a controversy arising between the employer and employee relative to the continuance of medical, surgical, hospital, or other treatment, the Industrial Commission may order such further treatments as may in the discretion of the Commission be necessary." (Emphasis added.) Additionally, the statute provides that "[t]he Commission may at any time upon the request of an employee order a change of treatment and designate other treatment suggested by the injured employee subject to the approval of the Commission." N.C.G.S. 97-25 (1985) (amended 1991) (emphasis added). Accordingly, this Court long ago concluded that "in case of a controversy arising relative to the continuance of any treatment the Industrial Commission may order such further treatment as may in its discretion be necessary, and . . . the Commission may change the treatment or designate other treatment suggested by the injured employee." Hedgepeth v. Casualty Co., 209 N.C. 45, 47, 182 S.E. 704, 705 (1936). The complete absence of an express or implied reference in N.C.G.S. 97-25 to any "change of condition" requirement, in addition to that statute's clear language permitting the Commission to review the medical treatment an employee is receiving and order further treatment at any time if an employee requests such a review, compel us to conclude that the legislature did not, intend for an injured employee to make any showing of a change in condition before his employer would be required to pay for further medical services or treatment needed as a result of his compensable injury.
We also conclude that the foregoing interpretation of N.C.G.S. 97-25 is consistent with the terms of N.C.G.S. 97-47. The legislature provided in N.C.G.S. 97-47 that:
Upon . . . the application of any party in interest on the grounds of a change in condition, the Industrial Commission may review any award, and on such review may make an award ending, diminishing, or increasing the compensation previously awarded, subject to the maximum or minimum provided in this Article . . . . No such review shall affect such award as regards any moneys paid but no such review shall be made after two years from the date of the last payment of compensation pursuant to an award under this Article, except that in cases in which only medical or other treatment bills are paid, no such review shall be made after 12 months from the date of the last payment of bills for medical or other treatment, paid pursuant to this Article.
This statute applies only to reviews of previously entered awards and provides that "on such review [the Commission] may make an award ending, diminishing, or increasing the compensation previously awarded." Id. (emphasis added). "Compensation" is defined in the Workers' Compensation Act as "the money allowance payable to an employee or to his dependents as provided for in this Article, and includ[ing] funeral benefits provided herein." N.C.G.S. 97-2(11) (1991). "Compensation" in the context of the Workers' Compensation Act refers to "money relief afforded according to a scale established and for the person designated in the Act." Ivey v. Prison Department, 252 N.C. 615, 619-20, 114 S.E.2d 812, 815 (1960) (quoting Branham v. Panel Co., 223 N.C. 233, 236, 25 S.E.2d 865, 867 (1943)). The amount of such "compensation" to be awarded to a claimant is based on the claimant's lost earning capacity. Ashley v. Rent-A-Car Co., 271 N.C. 76, 83, 155 S.E.2d 755, 761 (1967) (quoting Hill v. DuBose, 234 N.C. 446, 447-48, 67 S.E.2d 371, 372 (1951)). Medical and hospital expenses which employers must provide pursuant to N.C.G.S. 97-25 are not a part of "compensation" as it always has been defined in the Workers' Compensation Act. Id. at 82, 155 S.E.2d at 760. We previously have determined that the General Assembly intended medical and other payments rendered under N.C.G.S. 97-25 to "be in addition to the compensation to which [the employee] is entitled under the Act." Morris v. Chevrolet Co., 217 N.C. 428, 432, 8 S.E.2d 484, 486 (1940). We would have difficulty stating matters more clearly than we did when we said that:
In many jurisdictions the payment of medical expenses is held to be tantamount to the payment of compensation. However, under the definition of the word "compensation" contained in . . . [N.C.G.S. 97-2(11)], payment of medical or hospital expenses constitutes no part of compensation under the provisions of our Workmen's Compensation Act. Morris v. Chevrolet Co., 217 N.C. 428, 8 S.E.2d 484. Compensation is defined in our statute as the money allowance payable to an employee or his dependents, including funeral benefits.
Whitted v. Palmer-Bee Co., 228 N.C. 447, 453, 46 S.E. 109, 113 (1948); but cf. Biddix v. Rex Mills, 237 N.C. 660, 666, 75 S.E.2d 777, 782 (1953) (quoting with approval an opinion of an Industrial Commissioner which erroneously implied that the payment of medical bills was compensation).
The legislature's 1991 amendments to N.C.G.S. 97-25 and N.C.G.S. 97-2, although not yet in effect or controlling when the present case arose, merely clarified the legislative intent already expressed in our Workers' Compensation Act by emphasizing the legislature's continuing differentiation between medical expenses and "compensation" under the Act. In "An Act to make certain technical amendments to the Workers' Compensation Act and to increase assessments by the Industrial Commission for the Second Injury Fund," the legislature in 1991 added a new subsection (19) to N.C.G.S. 97-2, creating and defining the term "medical compensation," and also inserted the term "medical compensation" into N.C.G.S. 97-25 to replace the previous description of expenses covered under that section. 1991 N.C. Sess. Laws ch. 703, 1,3. The term "compensation," however, continues to be defined separately in N.C.G.S. 97-2(11) as "the money allowance payable to an employee or to his dependents as provided for in this Article, and includ[ing] funeral benefits provided herein." The 1991 amendments made it clear that under the Act, the relief obtainable as general "compensation" is different and is separate and apart from the medical expenses recoverable under the Act's definition of "medical compensation."
The General Assembly amended N.C.G.S. 97-25, effective 15 June 1991, by striking the following language and replacing it with the phrase "Medical compensation": Medical, surgical, hospital, nursing services, medicines, sick travel, rehabilitation services, and other treatment including medical and surgical supplies as may reasonably be required to effect a cure or give relief and for such additional time as in the judgment of the Commission will tend to lessen the period of disability, and in addition thereto such original artificial members as may be reasonably necessary at the end of the healing period. . . . 1991 N.C. Sess. Laws ch. 703, 3. The legislature also added subsection (19) to N.C.G.S. 97-2, which reads: Medical Compensation. — The term `medical compensation' means medical, surgical, hospital, nursing, and rehabilitative services, and medicines, sick travel, and other treatment, including medical and surgical supplies, as may reasonably be required to effect a cure or give relief and for such additional time as, in the judgment of the Commission, will tend to lessen the period of disability; and any original artificial members as may reasonably be necessary at the end of the healing period. 1991 N.C. Sess. Laws ch. 703 1.
The dissent would include medical payments provided under N.C.G.S. 97-25 within the meaning of general "compensation" in the Act, thereby ignoring the interpretation of the term "compensation" which is supported by the language of the Workers' Compensation Act and which we have applied for over 50 years. See Morris v. Chevrolet Co., 217 N.C. 428, 432, 8 S.E.2d 484, 486 (1940). As we have observed in the past, an interpretation
consistently given to the statute is as much a part of the statute as if expressly written in it. We have no right to change or ignore it. If it is to be changed, it must be done by the Legislature, the law-making power. If, in its wisdom, a change is desirable, it can readily do so.
Hensley v. Cooperative, 246 N.C. 274, 281, 98 S.E.2d 289, 294 (1957), quoted in O'Mary v. Clearing Corp., 261 N.C. 508, 511, 135 S.E.2d 193, 195 (1964). In our interpretation of the meaning of "compensation" under the Workers' Compensation Act, we adhere to the time-honored doctrine of stare decisis, and we decline to take the contrary position set out by the dissent.
We acknowledge that the terms of N.C.G.S. 97-47 tend to be ambiguous and somewhat confusing. In interpreting provisions of the Workers' Compensation Act, we note that the legislature intends "for the Workers' Compensation Act to be construed liberally in favor of the injured worker to the end that its benefits not be denied upon technical, narrow or strict interpretation." Harrell v. Harriet Henderson Yarns, 314 N.C. 566, 578, 336 S.E.2d 47, 54 (1985) (citing Cates v. Hunt Construction Co., 267 N.C. 560, 148 S.E.2d 604 (1966)). While a court should not construe the Act liberally in favor of an employee if such construction contravenes "the plain and unmistakable language of the statute," ambiguous provisions properly are interpreted in the employee's favor. See Rorie v. Holly Farms, 306 N.C. 706, 709-10, 295 S.E.2d 458, 461 (1982).
Bearing in mind the well-established definition of "compensation" within the Workers' Compensation Act and the legislative intent that provisions of the Act be interpreted liberally in favor of an employee-claimant, we conclude that N.C.G.S. 97-47 does not apply to an employee's right to claim medical payments under the Act. This section allows the Commission to review a prior award only for the purpose of making "an award ending, diminishing, or increasing the compensation previously awarded." (Emphasis added). Because "compensation" does not include the payment of medical expenses, this provision does not affect the Commission's grant or denial of an employee's request for the payment of those expenses. The Commission's authority for requiring an employer to pay the medical expenses of an injured employee is established by the terms of N.C.G.S. 97-25, which mandates that certain medical treatments "shall be provided by the employer" and establishes the conditions which must be present before the Commission may order the employer to pay for treatments.
The dissent's reliance on the portion of N.C.G.S. 97-47 which states that "except in cases in which only medical or other treatment bills are paid, no such review shall be made after 12 months from the date of the last payment of bills for medical or other treatment," is inapposite. This provision, although it does refer to cases in which the Commission's prior award allowed medical payments only, nonetheless applies only to the Commission's review for the purpose of "ending, diminishing, or increasing the compensation previously awarded." (Emphasis added). The provision applies to situations in which the Commission in its first award found that, while a workplace injury did require medical treatment, the injury did not result in any decreased earning capacity which would entitle the employee to general "compensation." If, within the time limitation following the Commission's award, the employee developed a decreased earning capacity as a result of the injury, the Commission then could reopen the case and award the general "compensation" which it previously had denied. This is not such a case.
In sum, we conclude that the legislature always has provided for, and continues to provide for, two distinct components of an award under the Workers' Compensation Act: (1) payment for the cost of medical care, now denominated "medical compensation," which consists of payment of the employee's medical expenses incurred as a result of a job-related injury; and (2) general "compensation" for financial loss other than medical expenses, which includes payment to compensate for an employee's lost earning capacity and payment of funeral expenses. While N.C.G.S. 97-47 requires a claimant to show a "change of condition" before the Industrial Commission may amend an order awarding general "compensation" as that term is and always has been defined in the Act, N.C.G.S. 97-25 permits the Industrial Commission to order the employer to pay new or additional medical expenses, even if there has been no material change in the employee's condition or in available medical treatments. The opinion of the Court of Appeals holding to the contrary in Shuler v. Talon Div. of Textron, 30 N.C. App. 570, 577, 227 S.E.2d 627, 631 (1976), is overruled.
This interpretation of N.C.G.S. 97-25 and N.C.G.S. 97-47 is consistent with the overall intent of the Workers' Compensation Act to allow recovery by employees for work-related injuries. See Evans v. ATT Technologies, 332 N.C. 78, 86, 418 S.E.2d 503, 509 (1992). As we so often have stated in the past, the Act should be liberally construed to effectuate its purpose; we will not deny an employee's benefits by a "narrow, technical, and strict construction" of the Act. Gunter v. Dayco Corp., 317 N.C. 670, 677, 346 S.E.2d 395, 399 (1986) (citing Keller v. Wiring Co., 259 N.C. 222, 130 S.E.2d 342 (1963)). Construing the Act as the defendants and the dissent propose would require a narrow interpretation of the Act, contrary to its terms and contrary to the legislature's intent to "compel industry to take care of its own wreckage." Barber v. Minges, 223 N.C. 213, 216-17, 25 S.E.2d 837, 839 (1943). We are not free to give the Act any such narrow interpretation. Accordingly, the unpublished decision of the Court of Appeals, reversing the order of the Industrial Commission in favor of the defendants and remanding this case to the Commission, is affirmed.
Affirmed.
Justices WEBB and PARKER did not participate in the consideration or decision of this case.