NC Claims Rep's Occupational Disease Claim for Anxiety and Depression Fails
A North Carolina appellate court affirmed a decision by the state’s Industrial Commission that denied an employee’s claim for an alleged occupational disease due to excessive stress and other pressures she faced while working as a senior claims representative for a prominent insurance carrier [Day v. Travelers Ins. Co., 2020 N.C. App. LEXIS 578 (Aug. 4, 2020)]. Applying the state’s definition of occupational disease found in N.C. Gen. Stat. § 97-53(13), the court agreed with the Commission that while the employee sustained “employment stressors” during her tenure of employment with the carrier, and while those stressors did cause or significantly contribute to the employee’s anxiety and depression, she nevertheless failed to that working as an insurance claims adjuster placed her at an increased risk of contracting anxiety and depression as opposed to the general public not so employed.
Background
The underlying facts in the case were strongly disputed by the parties. The employee offered evidence that she began employment with the carrier in September 1996, at its Reading, Pennsylvania office. She testified that while in Reading, she was given a workload that was greater than that given to others, that she frequently had to work overtime and that as a result of the carrier’s monitoring of employee progress and timeliness, she became stressed, anxious, and depressed.
She subsequently transferred to the carrier’s Charlotte, North Carolina office. She testified numerous aspects of this new position exacerbated her anxiety and stress including, but not limited to offensive comments made by clients about her being a woman and a “Northerner.” She testified further that her supervisor instructed her not to inform corporate representatives of the total number of files that she was handling, because she had more cases than prescribed by Travelers, and that her superiors asked that she submit fraudulent claims, undervalue or deny compensable claims, and lie to insureds. She testified that attempts to discuss these problems with supervisors were met with animus.
She testified she developed numerous medical symptoms in response to the stress, including rapid heartbeat, facial tingling, shaking of her limbs, and an increase in migraine headaches, which had plagued her for many years. She stopped working for the carrier in March 2013, but contended that she still suffered anxiety and depression, as well as the attendant medical conditions.
Industrial Commission’s Decision
The deputy commissioner denied her claim, finding that she had failed to show that she suffered from an occupational disease as defined by statute. The Full Commission affirmed and the employee appealed.
Court of Appeals Decision
The appellate court noted that the employee argued, in relevant part, that the Commission (1) applied the incorrect legal standard in determining whether she suffered from a compensable occupational disease; (2) improperly evaluated the testimony of her medical experts; and (3) disregarded certain testimony and other evidence favorable to her.
The court pointed out that certain diseases and conditions are deemed to be occupational diseases within the meaning of the North Carolina Act. In addition to those listed, the Act provided benefits for
Any disease, other than hearing loss … which is proven to be due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation or employment, but excluding all ordinary diseases of life to which the general public is equally exposed outside of the employment [§ 97-53(13)].
The court added that courts in North Carolina followed a three-part test laid down in Rutledge v. Tultex Corp., 308 N.C. 85, 301 S.E.2d 359 (1983), where the Supreme Court said an occupational disease was compensable where:
- It is “characteristic of persons engaged in the particular trade or occupation in which the claimant is engaged;
- Not an ordinary disease of life to which the public generally is equally exposed with those engaged in that particular trade or occupation; and
- The claimant establishes a causal connection between the disease and the claimant’s employment.
The appellate court stressed that Rutledge and subsequent case law applying its three-prong test made clear that evidence tending to show that the employment simply aggravated or contributed to the employee’s condition goes only to the issue of causation, the third element of the Rutledge test. The court added that here, the Commission specifically found that the employment stressors during the claimant’s employment with the carrier did contribute to her anxiety and depression.
But the Commission further found that claimant’s were the sort of ordinary stressors and diseases of life that were not characteristic of or peculiar to an insurance claims adjuster’s work, as opposed to occupations in general. Moreover, the Commission found that claimant’s job did not place her at an increased risk of contracting anxiety and depression as opposed to the general public not so employed.
Simply put, the Commission’s determination that she had not proved the had an occupational disease — as defined by the statute — was appropriate.