State commission sanctions Mission Hospitals over workers’ compensation claims

An official for a state commission that oversees the handling of workers' compensation claims has referred a recent case involving a former registered nurse at Mission Hospitals to the N.C. Attorney General's office for further investigation. It's an unusual move spurred by what the official, in his Sept. 22 decision on the case, said was an "established pattern and practice of bad faith in administering workers' compensation claims."

In a written statement, a hospital spokeswoman said the hospital can't make a statement regarding the allegations because litigation is ongoing. "Mission has not been notified of any investigation by the Department of Insurance or Attorney General's office, but remains willing and looks forward to cooperating with any such investigation," she said.

The most recent case had its start on Feb. 26, 2008, according to records on file with the N.C. Industrial Commission. That day, Terry Cawthorn reported a back injury after helping to move a patient from a gurney to a bed. At the time, Cawthorn was 47 years old and had worked for more than 20 years at Mission. Cawthorn's average weekly wages were $1,456.98, and should have yielded compensation pay of $786 a week, according to the records.

The hospital denied Cawthorn's claim, contending that since neither Cawthorn nor the patient she was assisting had slipped, tripped or fallen, her claim did not qualify for coverage. In making that finding, Mission's claims adjustor knowingly made a false statement "to mislead plaintiff and deny her workers' compensation benefits," according to the records.

Thomas F. Ramer, the Asheville attorney who represented Cawthorn, said the commission's decision was significant, and he cited other workers' compensation cases dating back to 2002 in which Mission Hospitals had been found to be engaging in bad faith in the handling of workers' compensation claims.

"Over the past seven years, Mission has been sanctioned by seven separate judges at the Industrial Commission," Ramer wrote in a letter to Xpress.

"These sanctions have been affirmed by five of the seven appellate judges at the commission. This evidences the pervasive pattern of Mission and not just some single judge who didn't like them."

The Industrial Commission oversees disputes about pay and compensation when an employee in North Carolina reports a work-related medical issue. Deputy commissioners travel the state to hear the disputes and decide claims, which can be appealed to the full commission and then on to the N.C. Court of Appeals and the state Supreme Court.

Cawthorn reported the injury to her supervisors, who sent the case up the chain of command and to the hospital's in-house adjuster, according to commission records. Cawthorn continued to work, and reported three other subsequent back injuries in March and May of 2008. Cawthorn, who had been moved to light duty, had back surgery in August 2008. On Sept. 9, 2009, the hospital notified Cawthorn that light-duty work "was no longer being made available to her and she was taken out of work as of that date," according to the records. Cawthorn had another back surgery in December 2008.

Deputy Commissioner George T. Glenn II, who found in favor of Cawthorn, wrote that Mission officials intentionally disregarded their own reports of Cawthorn's injury, as well as testimony before the commission and other evidence. Those actions were "unreasonable and based on stubborn, unfounded litigiousness," Glenn wrote.

In his decision, Glenn went on to explain that Mission has a history of cases before the commission in which the hospital has been "found to have unreasonably denied workers' compensation" and has been "sanctioned" to pay the workers' attorneys' fees. The Cawthorn case continues the hospital's "established pattern and practice of bad faith in administering workers' compensation claims," Glenn wrote.

Glenn awarded Cawthorn compensation of $786 a week for the period beginning Sept. 10, 2008 and "continuing until further order of the commission." He also ordered the hospital to pay for related medical treatment, as well as attorneys' fees.

Asheville Attorney David Gantt, who has successfully represented Mission Hospital workers before the Industrial Commission in past cases, said workers' compensation disputes "really do hit a very weak and vulnerable part of our society. The real tragedy of it is that Mission is supposed to help people, and here they're denying their own workers' claims."

Go to www.mountainx.com/xpressfiles to read the full Industrial Commission decision in the case of Terry Cawthorn and Mission Hospitals.