RANDY R. LEWIS, Employee, Plaintiff, v. BEACHVIEW EXXON SERVICE,
Employer, and PENN NATIONAL INSURANCE CO., Carrier, Defendants
The Industrial Commission erred in a workers' compensation case by failing to address
estoppel. It is undisputed that defendants paid plaintiff for three years after the Form 60 before
contesting compensability (N.C.G.S. § 97-18(d) requires that the claim be contested within ninety
days of the injury).
Judge STEELMAN concurring in part and dissenting in part.
Wilson & Ratledge, P.L.L.C., by Perry J. Pelaez, for
plaintiff-appellant.
Cranfill, Sumner & Hartzog, L.L.P., by Buxton S. Copeland &
Meredith T. Black, for defendant-appellees.
HUDSON, Judge.
Deputy Commissioner W. Bain Jones heard this case on 25
February 2002
and filed an opinion and award on 31 July 2002,
awarding plaintiff temporary total disability, medical benefits,
and attendant care for his claim related to his pulmonary
condition. Defendants appealed to the Full Commission which, on 30
January 2004, reversed the opinion of the deputy commissioner.
Plaintiff appeals. For the reasons discussed below, we remand the
case for further findings and conclusions.
The evidence tends to show that on 16 September 1997, while
working as a mechanic for defendant-employer, plaintiff felt a popand severe pain in the abdomen when he used a pry bar to change a
crankshaft. Plaintiff notified defendant-employer and went to
Carteret General Hospital (the hospital) the following day, where
he was diagnosed with a hernia. On 19 September 1997, Dr. Richard
Wray surgically repaired the hernia. Plaintiff was released from
the hospital the following day, 20 September 1997. On 21 September
1997, plaintiff developed chest tightness, shortness of breath, and
wheezing. He went back to the hospital, where he was diagnosed
with pneumococcal pneumonia and re-admitted. Plaintiff was treated
with antibiotics and discharged approximately one week later, with
a diagnosis of severe obstructive lung disease.
By 7 October 1997, plaintiff's hernia had healed. On 22
October 1997, Dr. Wray released plaintiff to work concerning his
hernia repair. However, Dr. Joseph Nutz continued to treat
plaintiff's pulmonary condition and did not release him to work.
On 25 October 1997, plaintiff again experienced chest tightness,
shortness of breath, coughing and congestion. He returned to the
hospital for four days and was diagnosed with chronic obstructive
pulmonary disease. Plaintiff had asthma as a child and smoked all
of his adult life.
In November 1997, defendants referred plaintiff to Dr. Ted
Kunstling, a pulmonary disease specialist. After examining
plaintiff, Dr. Kunstling determined that plaintiff had experienced
acute exacerbation of chronic obstructive pulmonary disease by a
lower respiratory infection, which occurred subsequent to his
inguinal hernia repair. In an evaluation letter to defendants'claims representative, Dr. Kunstling indicated that plaintiff's
pulmonary condition was causally related to the hernia operation.
Defendants then filed a Form 60, admitting plaintiff's right to
compensation as of 31 December 1997.
In April 1998, Dr. Kunstling indicated plaintiff could return
to work in jobs that required no strenuous exertion and no exposure
to dust, fumes, or extreme temperatures. On 28 May 1998, Dr.
Kunstling determined that plaintiff had reached maximum medical
improvement as to his asthma but would continue to need treatment
for future exacerbations. Although plaintiff was offered several
jobs, he was too symptomatic to accept employment, as verified by
Dr. Kunstling. On 13 May 1999, Dr. Kunstling indicated that
plaintiff was totally and permanently disabled due to his pulmonary
condition.
Plaintiff filed a Form 33 on 8 July 2000, for failure to pay
medical expenses. On 26 September 2000, defendants filed a Form
33R, contending that plaintiff's condition was not causally related
to his compensable injury from 16 September 1997. Then on 4
October 2000, defendant-carrier filed a Form 62, reducing
plaintiff's temporary total disability for alleged prior
miscalculation of the average weekly wage. Defendants hired Dr.
Gregory Pape, Chief of Pulmonary and Critical Care Medicine at East
Carolina School of Medicine, and Dr. Albert Schwartz, Chief of
Pulmonary Medicine at Duke University to review plaintiff's case.
Dr. Schwartz examined plaintiff on 8 February 2001, and Dr. Pape
evaluated him on 15 February 2001. Both doctors also reviewed themedical records and each independently concluded that plaintiff's
pulmonary condition was not the result of his surgery or hospital-
acquired pneumonia, but rather was the result of smoking, pre-
existing asthma, and community-based pneumonia acquired prior to
his hernia surgery.
Plaintiff's first three arguments in his brief essentially
assert that the Commission erred by failing to address his estoppel
defense. Plaintiff argues that N.C. Gen. Stat. § 97-18(d)(2000)
required defendants to contest plaintiff's claim within ninety days
from his injury and that they failed to do so. It is undisputed
that after filing a Form 60, defendants paid plaintiff for three
years before contesting the compensability of the injury.
Plaintiff contends that defendants waived their right to contest
compensability of his pulmonary condition when they did not contest
it within ninety days of the injury. Similarly, plaintiff argues
that because defendants paid him for three years without denying
his claim, that they should now be estopped from denying his claim.
Without addressing the merits of plaintiff's substantive arguments
here, we conclude that the Commission erred in failing to address
these issues.
The parties stipulated that the issues before both the deputy
commissioner and the Full Commission included whether defendants
are estopped from denying plaintiff's pulmonary condition. These
stipulations of the issues are set forth in both opinions. The
scope of this Court's review of an Industrial Commission decision
is limited: (1) the full Commission is the sole judge of the weight and
credibility of the evidence, and (2) appellate courts
reviewing Commission decisions are limited to reviewing
whether any competent evidence supports the Commission's
findings of fact and whether the findings of fact support the
Commission's conclusions of law.
Deese v. Champion Int'l Corp., 352 N.C. 109, 116, 530 S.E.2d 549,
553 (2000) (citing Adams v. AVX Corp., 349 N.C. 676, 509 S.E.2d 411
(1998)). We may not weigh the evidence and decide the issue on
the basis of its weight, but must only determine whether the
record contains any evidence tending to support the finding.
Adams, 349 N.C. at 681, 509 S.E.2d at 414 (internal citation and
quotation marks omitted). However, the Commission made no findings
of fact or conclusions of law regarding waiver or estoppel here.
While the Commission is not required to make findings as to
each fact presented by the evidence, it must find those crucial and
specific facts upon which the right to compensation depends.
Johnson v. Southern Tire Sales & Serv., 358 N.C. 701, 705, 599
S.E2d 508, 511 (2004) (internal citations and quotations omitted).
More specifically, the Commission must address the issue of
estoppel. Purser v. Heatherlin Properties, 137 N.C. App. 332, 338,
527 S.E.2d 689, 693 (2000); see also Bowen v. Cra-Mac Cable
Services, Inc., 60 N.C. App. 241, 247, 298 S.E.2d 760, 763 (1983).
Here, as in Purser, the Industrial Commission failed to consider
the application of the doctrine of estoppel to the factual scenario
at hand. 137 N.C. at 338, 527 S.E.2d at 693. Accordingly, we
remand this matter to the Industrial Commission for further
proceedings and to make findings of fact and conclusions of law
regarding all issues raised by the evidence upon which plaintiff'sright to compensation depends.
In light of this conclusion, we decline to address plaintiff's
other arguments.
Reversed and remanded.
Judge WYNN concurs.
Judge STEELMAN concurs in part and dissents in part in a
separate opinion.
STEELMAN, Judge concurring in part and dissenting in part.
I concur with the majority opinion, remanding this matter to
the Industrial Commission for further findings of fact and
conclusions of law on the issue of estoppel. This issue was
clearly before the Commission, is specifically mentioned in the
Opinion and Award, and was extensively discussed in Commissioner
Ballance's dissenting opinion. However, the Commission made no
findings of fact or conclusions of law on this issue.
I dissent as to the majority opinion's refusal to discuss the
remaining issues brought forward by plaintiff's appeal, and
specifically to the remanding of this case to the Commission,
allowing it to make findings and conclusions as to all issues
raised by the evidence upon which plaintiff's right to compensation
depends.
The estoppel issue is entirely separate and distinct from the
issue of whether plaintiff is entitled to receive compensation
under the facts of this case. If the Commission erred in not
awarding compensation, then this renders the estoppel question
moot. If the Commission properly denied compensation, then thislimits the scope of the Commission's review upon remand to the
question of estoppel.
Plaintiff brings forward four arguments challenging the
findings of fact and conclusions of law. Appellate review of an
order and award of the Industrial Commission is limited to a
determination of whether the findings of the Commission are
supported by the evidence and whether the findings in turn support
the legal conclusions of the Commission. This is so even though
there is evidence which would support a finding to the contrary.
Simon v. Triangle Materials, Inc., 106 N.C. App. 39, 41, 415 S.E.2d
105, 106 (1992) (citation omitted).
The essential facts in this case are not in dispute.
Plaintiff suffered a hernia on 16 September 1997 in the course and
scope of his employment. On 19 September 1997, the hernia was
surgically repaired, and plaintiff was released from the hospital
the following day. On 21 September 1997, plaintiff was admitted to
the hospital with pneumococcal pneumonia. Plaintiff was
subsequently found to be totally and permanently disabled as a
result of chronic obstructive pulmonary disease. The dispute in
this case is over the conflicting opinions of medical experts on
two points: (1) whether plaintiff contracted pneumococcal pneumonia
while hospitalized for his hernia surgery; and (2) whether the
pneumonia resulted in an exacerbation of his prior chronic
pulmonary disease.
As to the first point, plaintiff's expert, Dr. Kunstling,
based his opinion that the pneumonia was a complication of the
surgery' upon the temporal relationship between his hospitalizationand contracting pneumonia, and the type of pneumonia. Defendant's
expert, Dr. Pape, rendered an opinion that the pneumonia was
unrelated to his hospitalization. This was based upon the temporal
relationship between the hospitalization and the type of pneumonia.
Dr. Pape testified that when a patient develops pneumonia within 5
days of hospitalization, it was more likely acquired in the
community and not the hospital. Since plaintiff developed
pneumonia within two days of his hospitalization, it was acquired
in the community, prior to his hospitalization.
As to the second point, Dr. Kunstling gave an opinion that
plaintiff experienced an exacerbation of chronic obstructive
pulmonary disease by a lower respiratory infection, which occurred
subsequent to his surgical hernia repair. Dr. Pape testified that
plaintiff's subsequent respiratory problems were not related to his
hernia surgery. Defendant's other expert, Dr. Schwartz, testified
that the respiratory and pulmonary problems that plaintiff
experienced were unrelated to the hernia surgery. He further
opined that plaintiff's current condition was not aggravated by the
pneumonia.
The Commission made the following finding concerning the
testimony of these experts:
21. Though he treated plaintiff prior in time
to Dr. Pape and Dr. Schwartz, Dr. Kunstling is
not in a better position than these doctors to
determine whether plaintiff's hernia surgery
is the cause of plaintiff's subsequent
pulmonary and respiratory conditions. Dr.
Kunstling bases his causation opinion on
incorrect facts and on a temporal relation
between the hernia surgery and the respiratory
problems plaintiff has developed. Dr.
Kunstling's opinion is given less weight than
that of Dr. Pape and Dr. Schwartz, who bothopine that plaintiff's current pulmonary
conditions are a result of a combination of
his 20-plus year smoking history, his asthma
and the community-based pneumonia he acquired
prior to his hernia surgery.
The credibility of witnesses and the weight to be given to a
witness' testimony are matters for the Industrial Commission to
decide. Russell v. Lowes Prod. Distr., 108 N.C. App. 762, 765, 425
S.E.2d 454, 457 (1993). I would hold that there is evidence before
the Commission to support each of the challenged findings of fact.
It is irrelevant whether there is evidence that would support
contrary findings. Simon, 106 N.C. App. at 41, 415 S.E.2d at 106.
The opinions of each of the experts were proper and admissible.
When faced with conflicting expert opinions, it is for the
Commission to resolve these conflicts. Wagoner v. Douglas Battery
Mfg. Co., 80 N.C. App. 163, 164, 341 S.E.2d 120, 121 (1986)
(citation omitted). The Commission's findings support its
conclusions that the plaintiff's disability was not the result of
his hernia surgery.
I would affirm the Commission's decision that plaintiff's
pulmonary condition was not the result of his hernia surgery and is
not compensable, and that the hernia surgery did not materially
aggravate or exacerbate his pre-existing pulmonary condition.
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