Monroe v. MV Transp.

• Decision Date: 18 January 2022
• Docket Number: COA21-316
• Parties: Wendy MONROE, Employee, Plaintiff, v. MV TRANSPORTATION, Employer, Self-insured (Broadspire, Third-Party Administrator) Defendant.
• Court: North Carolina Court of Appeals

869 S.E.2d 28

Wendy MONROE, Employee, Plaintiff,

v.MV TRANSPORTATION, Employer, Self-insured (Broadspire, Third-Party Administrator) Defendant.

No. COA21-316

Court of Appeals of North Carolina.

Filed January 18, 2022

The Sumwalt Group, by Vernon Sumwalt, Charlotte, and Christa Sumwalt, for plaintiff-appellant.

Wilson Ratledge, PLLC, by Kristine L. Prati, Raleigh, for defendant-appellee.

ARROWOOD, Judge.

¶ 1 Wendy Monroe ("plaintiff") appeals from the North Carolina Industrial Commission's (the "Commission") opinion and award concluding plaintiff had not satisfied her burden of proof to establish that she was entitled to disability benefits. For the following reasons, we vacate the Commission's opinion and remand for additional findings.

I. Background

¶ 2 Plaintiff began working for MV Transportation ("defendant-employer") in April 2016 as a part-time dispatcher and bus driver, where she earned $10.50 per hour. At the time, plaintiff was in her late forties, had a bachelor's degree, and had been receiving Social Security disability benefits since 1994 for an unrelated medical condition.¹

¶ 3 Around 5:00 a.m. on 4 November 2016, plaintiff was performing a routine bus inspection. While checking the emergency windows, plaintiff "placed her left knee and part of her body weight on [a] bus seat and leaned towards the windows." Because the floor of the bus was wet and slippery, when plaintiff "stepped back with her right foot to reenter the bus aisle, she lost her footing, hit her left shin, and twisted her back and right knee." Plaintiff was able to catch herself, but "ended up leaning slightly backwards in an awkward position, with her left knee still on the seat."

¶ 4 Initially, plaintiff did not report the incident as she thought she had merely lightly injured her shin. However, "[w]ithin an hour" of the incident, plaintiff noticed "back pain, left shin pain, and pain in both her knees[,]" all of which interfered with her work. Thereafter, plaintiff reported the injury to her supervisor, who instructed plaintiff to seek treatment at "Med First Immediate Care and Family Practice."

¶ 5 Plaintiff made multiple visits to Med First Immediate Care and Family Practice. Plaintiff complained of pain in her lower back and knees; x-rays were performed on her lumbar spine, which "showed spondylosis

," and on her knees, which "were both negative." On 7 November 2016, plaintiff "attempted to work, but had so much pain and difficulty that she returned to Med First" and was referred to the emergency room. Plaintiff received various restrictions for her work, including, among others, alternating between sitting and standing, and avoiding lifting over 20 pounds. On a few occasions, plaintiff tried returning to work; however, she continued to experience pain and was ultimately relieved by her supervisor on 15 November 2016. After that, plaintiff never returned to work.

¶ 6 For the three years that followed, plaintiff attended many medical appointments, throughout which she was given multiple referrals, as well as physical therapy and injection therapy to manage her persistent pain. Particularly, an MRI of her right knee performed 15 February 2018 revealed "complete cartilage loss in the medial compartment and a root tear avulsion of the posterior horn of the medial meniscus." On 14 January 2019, plaintiff "presented with severe progressive right knee pain[,]" which she found at times intolerable, and "walked with a limp"; at this point, a doctor deemed plaintiff "an appropriate candidate for a right total knee arthroplasty

."

¶ 7 After seeking opinions regarding partial knee replacement surgery versus a full knee replacement, plaintiff "was scheduled for a partial knee replacement on March 21, 2019, but ... had to reschedule it because of the availability of a home health care nurse." The surgery was then scheduled for 11 April 2018; however, due to a "miscommunication" and "complication with one of her medications," the surgery was canceled.

¶ 8 Plaintiff's claim, which was originally denied, was ultimately heard before Deputy Commissioner Lori A. Gaines (the "Deputy Commissioner") on 14 June 2019. At that time, "[p]laintiff was waiting to schedule the partial knee replacement surgery."

¶ 9 At the hearing, plaintiff introduced as her exhibits, among other things, medical records pertaining to her injury. Many of these medical records showed that multiple medical providers described plaintiff's "work status" following her injury as: "Unable to work secondary to dysfunction." After the hearing, "the parties took depositions of Dr. Arlene Hallegado, Stephen Free, PA-C, and Dr. Robert Boswell." During their respective depositions, all three medical professionals opined that they would have recommended work restrictions for plaintiff as a result of her injury and ongoing treatment.

¶ 10 In an opinion and award filed 7 February 2020, the Deputy Commissioner concluded that plaintiff had proven her injury was caused by an accident, and, "[b]ased upon a preponderance of the evidence in view of the entire record, ... that [p]laintiff ha[d] proven a causal connection between her November 4, 2016 work-related accident and the injuries to her low back and right knee." Then, the Deputy Commissioner found that "[f]rom November 7, 2016 to November 14, 2016 until her release to limited duty with restrictions, [p]laintiff was written entirely out of work." "Therefore," the Deputy Commissioner concluded that plaintiff had "met her burden of proving disability for that period of time."

¶ 11 The Deputy Commissioner continued:

Plaintiff was given limited duty restrictions on November 11, 2016 but was not written out of work after that date. However, in order to determine Plaintiff's loss of wage-earning capacity, the Commission must take into account the significant restrictions Plaintiff has been provided, her age, her work history, her ongoing back and right knee pain, and her education.... Taking these factors into account, the undersigned concludes that because of her compensable injuries, Plaintiff has been unable to earn wages in the same or similar employment, and therefore she is entitled to total disability compensation beginning November 15, 2016, and continuing until she returns to work, until further order of the Industrial Commission, or until compensation is otherwise legally terminated.

(Emphasis added.) Then, the Deputy Commissioner concluded that plaintiff was "entitled to medical compensation for such treatment as is reasonably necessary to effect a cure, provide relief, or lessen the period of disability associated with [her] conditions related to the November 4, 2016 injuries."

¶ 12 The Deputy Commissioner awarded plaintiff the following: that defendant-employer "shall pay temporary total disability compensation to plaintiff at the rate of $131.24 per week² for the period from November 15, 2016 and continuing until plaintiff returns to work or further order of the Commission, [and] any amounts having accrued shall be paid in lump sum"; that plaintiff was entitled to have defendant-employer "provide all medical treatment, incurred or to be incurred, necessitated by the compensable 4 November 2016 injuries by accident, including but not limited to the proposed surgery for plaintiff's right knee replacement surgery"; and "[a] reasonable attorney's fee in the amount of twenty-five percent ...."

¶ 13 Defendant filed notice of appeal on 10 February 2020 to the Full Commission. The appeal was heard on 21 July 2020.

¶ 14 In an Opinion and Award filed 3 March 2021, the Commission found, among other things, that plaintiff was 51 years old at the time of the second hearing, had begun working for defendant-employer in 2016 as a part-time dispatcher and bus driver, where she earned $10.50 per hour, and had been receiving Social Security disability benefits for an unrelated medical condition since 1994.

¶ 15 The Commission found that, on 4 November 2016, plaintiff incurred an injury as described before the Deputy Commissioner, as a result of which plaintiff received work restrictions. Plaintiff had returned to work on 15 November 2016, but was relieved by her supervisor due to pain; thereafter, she never worked again. The Commission also found that, between November 2016 and November 2019, plaintiff underwent multiple medical examinations with multiple doctors, which included MRIs, physical therapy, injection therapy, referrals, use of a knee brace, and recommendations for surgery.

¶ 16 The Commission found that, at the time of the hearing, plaintiff had not yet undergone surgery "for various reasons, including a complication with her medications and a miscommunication with scheduling," but intended to do so. The Commission also found plaintiff had not looked for work, or "worked in any capacity," since 15 November 2016. The Commission made no findings pertaining to the medical records included in plaintiff's exhibits regarding plaintiff's work status as being described as "[u]nable to work secondary to dysfunction."

¶ 17 Then, the Commission found, "[b]ased upon the preponderance of the evidence in view of the entire record," that plaintiff's "low back and right knee conditions and current need for treatment [we]re causally related to her incident at work on November 4, 2016." It further found that plaintiff's "treatment for her low back and right knee conditions, and her need for additional treatment, [were] reasonably necessary to effect a cure or provide relief of [her] conditions." The Commission then found that, although plaintiff "ha[d] some work restrictions related to her low back and right knee conditions[,] ... she is not restricted from all work."

¶ 18 The Commission concluded plaintiff's 4 November 2016 incident constituted an "accident" under North Carolina law, and that plaintiff had "met her burden of proving a causal relationship between her medical conditions and the accident." Thus, "plaintiff [wa]s entitled to payment of medical treatment for...