In the case of Dunbar v. Acme Southern, the employee sustained a compensable injury in 1998. He entered a settlement agreement to resolve all indemnity benefits. The agreement allowed the employee’s medical compensation to continue. The employee continued to receive medical treatment and the carrier continued to pay for the treatment. However, in 2013 the medical providers began to bill Medicare instead of the carrier. The carrier and the employee did not know about the change in billing and over two years elapsed with the carrier not paying further medical compensation since 2013.
The employee was then referred to a medical provider for pain management. The carrier was asked to authorize, and the carrier denied the treatment. In 2018, the employee filed a Form 33 Request for Hearing for a determination on entitlement for additional medical compensation. The deputy commissioner entered an Opinion and Award concluding that the employee was not entitled to continued medical compensation and the Full Commission affirmed the determination.
On appeal to the Court of Appeals, the employee made several arguments including notice, estoppel, and due process. Ultimately, all of the employee’s arguments failed. The Court of Appeals determined N.C. Gen. Stat. § 97-25.1 stating that “[t]he right to medical compensation shall terminate two years after the employer’s last payment of medical or indemnity compensation” applied in this case. Arguments related to statutory construction could not overcome the plain language of the statute. Therefore, the Court of Appeals affirmed the Full Commission Opinion and Award and the employee’s claim for additional medical compensation was denied.
Practice Tip – The language of N.C. Gen. Stat. § 97-25.1 is very clear and if there has not been a payment on a claim in two years the entitlement to additional medical compensation is barred with only two very specific exceptions. It is always important to monitor payments on claims and ensure that payment is not resumed after a two-year break.
