{ "id": 8549640, "name": "PATRICIA MORSE, Employee v. MRS. KATHRYN F. CURTIS, Employer, and INSURANCE COMPANY OF NORTH AMERICA, Carrier", "name_abbreviation": "Morse v. Curtis", "decision_date": "1973-12-12", "docket_number": "No. 7329IC592", "first_page": "96", "last_page": "101", "citations": [ { "type": "official", "cite": "20 N.C. App. 96" } ], "court": { "name_abbreviation": "N.C. Ct. App.", "id": 14983, "name": "North Carolina Court of Appeals" }, "jurisdiction": { "id": 5, "name_long": "North Carolina", "name": "N.C." }, "cites_to": [ { "cite": "172 S.E. 2d 495", "category": "reporters:state_regional", "reporter": "S.E.2d", "opinion_index": -1 }, { "cite": "276 N.C. 371", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8561448 ], "opinion_index": -1, "case_paths": [ "/nc/276/0371-01" ] }, { "cite": "170 S.E. 2d 491", "category": "reporters:state_regional", "reporter": "S.E.2d", "opinion_index": -1 }, { "cite": "6 N.C. App. 620", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8550032 ], "opinion_index": -1, "case_paths": [ "/nc-app/6/0620-01" ] }, { "cite": "170 S.E. 2d 493", "category": "reporters:state_regional", "reporter": "S.E.2d", "opinion_index": -1 }, { "cite": "6 N.C. App. 591", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8549708 ], "opinion_index": -1, "case_paths": [ "/nc-app/6/0591-01" ] }, { "cite": "305 S.W. 2d 45", "category": "reporters:state_regional", "reporter": "S.W.2d", "case_ids": [ 10157715 ], "year": 1957, "opinion_index": 0, "case_paths": [ "/sw2d/305/0045-01" ] }, { "cite": "115 N.W. 2d 101", "category": "reporters:state_regional", "reporter": "N.W.2d", "year": 1962, "opinion_index": 0 }, { "cite": "366 Mich. 319", "category": "reporters:state", "reporter": "Mich.", "case_ids": [ 1880378 ], "year": 1962, "opinion_index": 0, "case_paths": [ "/mich/366/0319-01" ] }, { "cite": "37 Ala. App. 222", "category": "reporters:state", "reporter": "Ala. App.", "case_ids": [ 1696957 ], "weight": 2, "year": 1953, "opinion_index": 0, "case_paths": [ "/ala-app/37/0222-01" ] }, { "cite": "128 S.E. 2d 570", "category": "reporters:state_regional", "reporter": "S.E.2d", "pin_cites": [ { "page": "576" } ], "opinion_index": 0 }, { "cite": "258 N.C. 226", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8560169 ], "pin_cites": [ { "page": "235" } ], "opinion_index": 0, "case_paths": [ "/nc/258/0226-01" ] }, { "cite": "105 S.E. 2d 439", "category": "reporters:state_regional", "reporter": "S.E.2d", "pin_cites": [ { "page": "446" } ], "opinion_index": 0 }, { "cite": "249 N.C. 74", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8608162 ], "pin_cites": [ { "page": "83" } ], "opinion_index": 0, "case_paths": [ "/nc/249/0074-01" ] }, { "cite": "134 S.E. 2d 321", "category": "reporters:state_regional", "reporter": "S.E.2d", "opinion_index": 0 }, { "cite": "261 N.C. 243", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8572765 ], "opinion_index": 0, "case_paths": [ "/nc/261/0243-01" ] }, { "cite": "75 S.E. 2d 777", "category": "reporters:state_regional", "reporter": "S.E.2d", "pin_cites": [ { "page": "781" } ], "opinion_index": 0 }, { "cite": "237 N.C. 660", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8617436 ], "pin_cites": [ { "page": "664" } ], "opinion_index": 0, "case_paths": [ "/nc/237/0660-01" ] }, { "cite": "277 N.C. 117", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8563170, 8563270, 8563121, 8563090, 8563221, 8563190 ], "opinion_index": 0, "case_paths": [ "/nc/277/0117-03", "/nc/277/0117-06", "/nc/277/0117-02", "/nc/277/0117-01", "/nc/277/0117-05", "/nc/277/0117-04" ] }, { "cite": "174 S.E. 2d 292", "category": "reporters:state_regional", "reporter": "S.E.2d", "opinion_index": 0 }, { "cite": "8 N.C. App. 259", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8550639 ], "opinion_index": 0, "case_paths": [ "/nc-app/8/0259-01" ] }, { "cite": "50 S.E. 2d 509", "category": "reporters:state_regional", "reporter": "S.E.2d", "opinion_index": 0 }, { "cite": "229 N.C. 472", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 12166565 ], "opinion_index": 0, "case_paths": [ "/nc/229/0472-01" ] }, { "cite": "50 S.E. 2d 504", "category": "reporters:state_regional", "reporter": "S.E.2d", "opinion_index": 0 }, { "cite": "229 N.C. 465", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 12166546 ], "opinion_index": 0, "case_paths": [ "/nc/229/0465-01" ] } ], "analysis": { "cardinality": 523, "char_count": 10766, "ocr_confidence": 0.604, "pagerank": { "raw": 3.6856254361847664e-07, "percentile": 0.892098535474462 }, "sha256": "d7dbf0a6acf7e6ae4eb4e41e2b53d155471bfc1f6f681ecc119950055f1dbcac", "simhash": "1:8577ce0a10ff6617", "word_count": 1737 }, "last_updated": "2023-07-14T15:39:00.958655+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [ "Judges Morris and VauChn concur." ], "parties": [ "PATRICIA MORSE, Employee v. MRS. KATHRYN F. CURTIS, Employer, and INSURANCE COMPANY OF NORTH AMERICA, Carrier" ], "opinions": [ { "text": "BALEY, Judge.\nThe defendants in this compensation case do not deny that they are liable for the payment of medical and related expenses incurred by plaintiff or her father as a result of injuries sustained by her from an accident arising out of and in the course of her employment. They contend, however, that such expenses are subject to the approval of the Industrial Commission based upon competent evidence as to their validity and amount.\nG.S. 97-90 authorizes the Commission to exercise control over the legal and medical charges permitted under the Workmen\u2019s Compensation Act as follows:\n\u201c(a) Fees for attorneys and physicans and charges of hospitals for services and charges for nursing services, medicines and sick travel under this Article shall be subject to the approval of the Commission . . . . \u201d\nSee also Worley v. Pipes, 229 N.C. 465, 50 S.E. 2d 504; Matros v. Owen, 229 N.C. 472, 50 S.E. 2d 509; Wake County Hospital v. Industrial Comm., 8 N.C. App. 259, 174 S.E. 2d 292, cert. denied, 277 N.C. 117.\nG.S. 97-26 provides:\n\u201cThe pecuniary liability of the employer for medical, surgical, hospital service, nursing services, medicines, sick travel or other treatment required when ordered by the Commission, shall be limited to such charges as prevail in the same community for similar treatment of injured persons of a like standard of living when such treatment is paid for by the injured person . . . . \u201d\nEven when the employer has voluntarily paid for medical care of an employee, the court in Biddix v. Rex Mills, 237 N.C. 660, 664, 75 S.E. 2d 777, 781, stated:\n\u201cWhen liability for the medical care of an employee who has suffered an accident is voluntarily incurred by the employer, the bills therefor must be approved by the Commission before the employer can demand reimbursement from its insurance carrier. In this manner such expenditures are kept within the schedule of fees and charges adopted by the Commission. G.S. 97-26.\u201d\nThe clear intent of these statutes and judicial opinions is to assure that medical and related expenses incurred by an injured employee for which the employer or his insurance carrier is to be liable shall be kept within reasonable and appropriate limits, and the responsibility for the enforcement of these limits rests upon the Industrial Commission. Indeed, under G.S. 97-90, it would be a misdemeanor for any person to receive fees which were not approved by the Commission.\nIn the present case an opinion and award was entered 23 July 1971 by a Deputy Commissioner which directed the defendants to pay all medical expenses and hospital expenses arising as the result of the plaintiff\u2019s injury \u201cafter bills for the same have been submitted to and approved by the North Carolina Industrial Commission.\u201d No bills were submitted to or approved by the Commission, and seven months later, on 23 February 1972, the Deputy Commissioner without further hearing found that \u201ccertain of these bills\u201d totaling $21,163.91 had been paid by the father of plaintiff and ordered that defendants reimburse the father for such payments. In our opinion the Deputy Commissioner was without authority to change his order ex mero motu and deprive defendants of a material right to have the bills for medical and related services submitted to and approved by the Commission. Stanley v. Brown, 261 N.C. 243, 134 S.E. 2d 321. Approval by the Commission is required by statute as well as the original order of the Deputy Commissioner and is not to be a routine or perfunctory act, but the exercise of a discretionary judgment based upon the evidence.\nIn Brice v. Salvage Co., 249 N.C. 74, 83, 105 S.E. 2d 439, 446, the court in a case involving the approval, by the Commission of a legal fee stated: \u201cAnd the word \u2018approve\u2019 as used in decisions of this Court implies the exercise of discretion and judgment. . . . Indeed, Black\u2019s Law Dictionary defines it \u2018 \u201c the act of approval\u201d imports the act of passing judgment, the use of discretion and determination as a deduction therefrom.\u2019 \u201d\nThe action of the Deputy Commissioner denied to the defendants the opportunity to question specific bills concerning medical and related expenses of the plaintiff and to aid the Commission in determining if the charges were excessive. Until the bills were known, defendants were not in any position to object to them or to offer any evidence that they exceeded the limits for such charges as prevail in the same community for similar treatment. See Bass v. Mecklenburg County, 258 N.C. 226, 235, 128 S.E. 2d 570, 576.\nUpon review before the Full Commission the only evidence in the record with respect to the medical and related expenses is the testimony of the father of the plaintiff. He testified that he had paid the sum of $21,163.91 for such expenses as the result of treatment rendered to plaintiff for injuries received in the accident. With very limited exceptions there is no evidence showing to whom these payments were made, at what time, or for what purpose. The medical doctors who testified did not specify the compensation which they received for their specific services, and there is no statement from any hospitals setting out the expense of plaintiff\u2019s hospitalization, the time involved, or any of the details of the treatment. The burden of showing the medical and related expenses incurred as a result of a compensable injury is upon the claimant who seeks payment therefor. Mitchell Motor Co. v. Burrow, 37 Ala. App. 222, 66 So. 2d 198 (1953); Boyer v. Service Distribs., Inc., 366 Mich. 319, 115 N.W. 2d 101 (1962); Gonzales v. Johnston Foil Mfg. Co., 305 S.W. 2d 45 (Mo. App. 1957). The award of the Full Commission shows that the Commission \u201cwould have preferred that a detailed statement of the medical expenses incurred by plaintiff would have been placed in evidence\u201d and recites that \u201c[a] strict view of the evidence in the case regarding expenditures for medical services could require a remand of the case for the purpose of receiving additional evidence regarding such question.\u201d\nWhile it is unfortunate that a settlement of this matter must be further delayed, the defendants are entitled to know the medical and related expenses which they are required to pay and to have an opportunity to be heard concerning their validity and amount. Accordingly, this cause is remanded to the Industrial Commission for additional hearing with respect to the medical and related expenses incurred by plaintiff as a result of her compensable injury.\nRemanded.\nJudges Morris and VauChn concur.", "type": "majority", "author": "BALEY, Judge." } ], "attorneys": [ "Uzzell & DuMont and Francis M. Coiner, by Harry DuMont, for plaintiff appellee.", "Roberts and Cogburn, by Landon Roberts, for defendant appellants." ], "corrections": "", "head_matter": "PATRICIA MORSE, Employee v. MRS. KATHRYN F. CURTIS, Employer, and INSURANCE COMPANY OF NORTH AMERICA, Carrier\nNo. 7329IC592\n(Filed 12 December 1973)\nMaster and Servant \u00a7 75 \u2014 workmen\u2019s compensation \u2014 medical expenses \u2014 necessity for itemized bills\nThe Industrial Commission erred in ordering defendants to reimburse claimant\u2019s father a sum of $21,163.91 for medical and related expenses he testified he had paid as a result of treatment rendered claimant for her injuries where no itemized bills for such medical and related expenses were submitted to the Industrial Commission, and the cause is remanded for an additional hearing with respect to such expenses. G.S. 97-26; G.S. 97-90.\nAppeal by defendants from opinion and award of the Industrial Commission entered 5 March 1973.\nPlaintiff sustained serious personal injuries on 15 August 1964 while employed by defendant Kathryn F. Curtis. After the determination of various jurisdictional and procedural matters (Morse v. Curtis, 6 N.C. App. 591, 170 S.E. 2d 493; Morse v. Curtis, 6 N.C. App. 620, 170 S.E. 2d 491; and Morse v. Curtis, 276 N.C. 371, 172 S.E. 2d 495) the case was heard in pertinent part before Deputy Commissioner A. E. Leake on 10 November 1970. By stipulation the issues to be determined at such hearing were \u201cwhat amount the plaintiff is entitled to receive as compensation for temporary total disability, temporary partial disability, for permanent disability, and . . . what medical and incidental benefits she is entitled to receive.\u201d\nThe evidence submitted at the hearing before Deputy Commissioner Leake by the plaintiff concerned the extent of her injuries and medical treatment. Over objection by the defendants the father of the plaintiff was permitted to testify that he had incurred expenses in the amount of $21,163.91 as a result of the treatment rendered his daughter for her injuries. No itemized bills for medical, surgical, hospital service, nursing or other incidental medical benefits were submitted in support of the testimony of plaintiff\u2019s father. On 23 July 1971 Deputy Commissioner Leake filed an opinion and award allowing plaintiff $12,000.00, the maximum permissible amount, as compensation for her injuries, and this amount the defendants have paid. The opinion also made the following finding of fact concerning the medical and related expenses:\n\u201c10. The plaintiff\u2019s total medical expenses in Hender-sonville, North Carolina, in 1964 in connection with the treatment of her injury by accident amounted to $1,193.87. The total medical and related expenses incidental to plaintiff\u2019s first trip to New York City for the purpose of undergoing treatment for injury received in the stipulated accident amounted to $7,551.13. The total medical and incidental expenses of the plaintiff\u2019s second trip to New York City for the same purpose amounted to $8,693.11. In the treatment of the plaintiff\u2019s injuries received in the stipulated accident the plaintiff incurred total medical and related expenses amounting to $21,163.91. These expenses have been paid by the plaintiff\u2019s father, Mr. Bleecker Morse.\u201d\nand provided:\n\u201c6. Defendants shall pay all medical expenses and hospital expenses arising as a result of the plaintiff\u2019s injury, after bills for the same have been submitted to and approved by the North Carolina Industrial Commission.\u201d\nPlaintiff never submitted any bills for the Commission\u2019s approval. However, on 23 February 1972, without notice to defendants, Deputy Commissioner Leake modified paragraph six of his award by adding the following sentence:\n\u201cCertain of these bills in the total amount of $21,163.91 having heretofore been paid by Bleecker Morse, father of the plaintiff, as set out in finding of fact number 10, are hereby approved, and the defendants are hereby ordered to make payment to Bleecker Morse in the amount of $21,163.91 to reimburse him for funds expended by him for treatment of plaintiff\u2019s injuries.\u201d\nFrom this action of the Deputy Commissioner defendants appealed to the Full Commission. The Full Commission affirmed, and defendants have appealed to this Court.\nUzzell & DuMont and Francis M. Coiner, by Harry DuMont, for plaintiff appellee.\nRoberts and Cogburn, by Landon Roberts, for defendant appellants." }, "file_name": "0096-01", "first_page_order": 124, "last_page_order": 129 }