Diamond Post
Workers' Compensation Newsletter
Do I have to pay TTD to a claimant who temporarily stops medical treatment for his work-related injury due to an unrelated medical condition?
Employers and adjusters frequently question whether or not they have to pay temporary total disability ("TTD") benefits in situations where the injured claimant's medical treatment is temporarily suspended due to an unrelated condition, such as pregnancy, stroke, or heart disease.
Orr v. Elastomeric Products, 323 S.C. 342, 474 S.E.2d 448 (S.C.App. 1996) is the seminal case in South Carolina dealing with this issue. The claimant, Orr, injured her back in the course and scope of her employment while lifting a box of parts. She initially received conservative treatment for her injury, but eventually had spinal surgery. She received TTD benefits throughout her treatment. While undergoing physical therapy, Orr discovered she was pregnant. Her doctors recommended that she discontinue her physical therapy for the duration of her pregnancy. Elastomeric, the employer, filed for a hearing to stop payment of Orr's TTD benefits on the ground that she had reached MMI. They also requested credit for all TTD benefits paid from the date Orr had discontinued her treatment.
The single commissioner determined that Orr had reached MMI and granted Elastomeric's application to stop payment of TTD and medical expenses as of the date of MMI. The full commission found that Orr had not reached MMI and had not refused medical treatment, but rather was unable to continue with her treatment due to her pregnancy. However, the full commission denied Orr's request to reinstate her TTD benefits, and ordered her to return to her doctors for further treatment. The circuit court affirmed the full commission and held that because Orr's pregnancy was not related to her employment or work-related injury, she was not "disabled" as the term is defined under South Carolina workers' compensation law, and Elastomeric did not have to pay TTD benefits during the time she was not participating in her treatment program.
The Court of Appeals reversed, and held that because the full commission made unappealed findings of fact that Orr had not reached MMI and did not refuse medical care, the lower courts erred in allowing Elastomeric to stop payment of TTD benefits. The court held that the fact that Orr's pregnancy indirectly prolonged the period during which she was unemployable did not change the fact that her injury, not her pregnancy, rendered her unable to work.
Debbie Brown, a member of GWB's Workplace Practices Group, has been recertified by the South Carolina Supreme Court as a specialist in Employment and Labor Law. Her practice focuses on representing the local and regional business community with employment law and workers' compensation needs.
Independent Medical Evaluations ("IME's) performed on or after December 15, 2009, will no longer subject to the standard maximum allowable payment of $600 because the SCWCC voted to remove IME's from the Medical Services Provider Manual.
The SCWCC suspended the use of the Form 40, Request for Expedited Hearing, at its Full Commission Business Meeting in March. The Commission will now adjudicate all motions through the regular process pursuant to Regulation 67-215.
The SCWCC also determined at the Full Commission Business Meeting that hearing transcripts will be required at all Full Commission Reviews. |
