What Medical Treatment Is My Employer Responsible For Paying For Following My Injury At Work?

The North Carolina Supreme Court recently addressed this issue in Kluttz-Ellison v. Noah’s Playloft Preschool (2024). In this case the injured employee had a total knee replacement surgery prior to her work-related injury, and she had struggled with weight issues for many years prior to her work-related injury. The injured employee’s treating physician determined that her injury at work caused the need for her to undergo surgery to address the loosing hardware for her prior total knee replacement surgery. However, the injured employee’s treating physician recommended she undergo bariatric weight loss surgery prior to the additional surgery for her knee.

The issue which ultimately came before the North Carolina Supreme Court was, what medical treatment is “directly related” to the injured employee’s injury at work such that her employer would be responsible for payment for the medical treatment?

The North Carolina Supreme Court in this case officially adopted the “directly related” test to determine what medical treatment an employer was responsible for paying for due to an injured employee’s injury at work. The “directly related” test requires a showing that the medical condition for which treatment is sought was either:

1. Caused by the workplace injury
2. Aggravated by the workplace injury
3. A condition that did not require medical treatment of any kind before the workplace injury, but now requires treatment solely to remedy the workplace injury.

In applying the “directly related” test to this case, the North Carolina Supreme Court determined that the employer was responsible for paying for the additional surgery for the injured employee’s knee because this was a medical condition aggravated by the workplace injury; however the employer was not responsible for paying for the bariatric weight loss surgery because this was a medical condition which required treatment prior to The Workplace Injury and the weight loss surgery was not to solely remedy the workplace injury. The North Carolina Supreme Court made clear that when addressing the issue of whether the employer should be responsible for payment for inured employee’s medical treatment, the analysis of this issue turns on whether the injuries and symptoms, not the medical treatment, for the injured employee are causally related to the workplace injury.

Should you have any questions about this or any of issues involving your work-related injury, please feel free to reach out to one of the Board Certified Workers’ Compensation Specialists at Cardinal Law Partners for a free consultation by calling (833) 444-4127.