Teague Campbell: The Last Medical Payment Is the Last Medical Payment

Tuesday, December 20, 2016 | 0

Kelly Lewis worked as a bus operator for Transit Management of Charlotte (“Charlotte Transit”). He suffered an admittedly compensable back injury on June 15, 2009, when the bus he was driving was rear-ended. A Form 25R was completed wherein Lewis was assigned a 0% permanent partial disability rating.

The last medical expense payment was issued on April 22, 2010. On April 28, 2014, more than four years later, Lewis filed a Form 18 related to the June 15, 2009, accident. Charlotte Transit filed a Form 61 denying the claim based on the expiration of the statute of limitations pursuant to N.C.G.S. § 97-25.1.

Lewis filed a Form 33 hearing request, claiming that additional indemnity benefits were owed due to an underpayment as a result of a miscalculation of his average weekly wage. He also claimed entitlement to additional medical benefits.

The deputy commissioner found in favor of Lewis and awarded additional benefits. The full commission modified the deputy commissioner’s opinion and award, and concluded that Lewis was entitled to $718.90 for an underpayment of indemnity benefits, but that his right to additional medical treatment had expired two years after the last medical payment was made on April 22, 2010. Lewis and Charlotte Transit both appealed to the North Carolina Court of Appeals.

On Dec. 6, 2016, in Lewis v. Transit Management of Charlotte, the Court of Appeals affirmed the full commission and held that the two-year statute of limitations on medical treatment had expired. 

The court noted the last medical payment was made on April 22, 2010. As such, the two-year statute of limitations in N.C.G.S. § 97-25.1 expired on April 22, 2012. The court rejected Lewis’ argument that the date the corrective indemnity underpayment was issued pursuant to the full commission’s opinion and award, as opposed to the date of the last medical payment, was the date from which to start the two-year statute of limitations. 

The court specifically indicated that the corrective payment for miscalculation of average weekly wage ordered by the full commission could not be the last payment under a straight reading of N.C.G.S.  § 97-25.1. The court noted that this result would run contrary to the goal of the Workers’ Compensation Act to “provide not only a swift and certain remedy to injured workers, but also to ensure a limited and determinate liability for employers.”

In addition, the court wanted to avoid increased litigation where there were honest miscalculations of indemnity benefits. Therefore, the court held that Lewis was limited to receiving the underpayment for indemnity benefits and was otherwise barred from receiving additional medical benefits pursuant to the two-year statute of limitations outlined in N.C.G.S. § 97-25.1.
 
Risk-handling hint: The Lewis decision highlights the challenge in making corrective payments when there is an applicable statute of limitations. In these situations, an Industrial Commission order may be needed to invoke the protection outlined in Lewis. Employers and carriers are encouraged to seek legal counsel before making voluntary corrective payments if the statute of limitations could be impacted.

This risk alert was published by Teague Campbell Dennis & Gorham LLP of Raleigh, North Carolina. It appears here with permission.