## Facts

- Rhonda Hamilton worked for Shawnee Management Corporation at a Hardee’s restaurant.
- In October 1991, Hamilton slipped on a wet floor at work and injured her back.
- The parties entered an award for temporary total disability benefits in November 1991.
- In January 1993, Hamilton underwent back surgery to treat the compensable injury.
- Several months later, her treating physician, Dr. Zoller, released her to return to work with light-duty restrictions.
- Shawnee prepared a job description for a modified cashier position and sent it to Dr. Zoller, who indicated Hamilton could perform that job within her restrictions.
- Hamilton declined the cashier job, stating Shawnee had not guaranteed enough hours to make the long commute worthwhile.
- In September 1993, Shawnee filed an application to suspend benefits based on Hamilton’s refusal of suitable selective employment.
- In August 1994, while Shawnee’s application was pending, Dr. Zoller referred Hamilton to Dr. John Kostuik for a second opinion.
- Kostuik recommended additional surgery; both Kostuik and Zoller agreed Hamilton could not have the procedure unless she stopped smoking and lost weight.
- Hamilton had stopped smoking for about 18 months around the time of her first surgery but had resumed smoking before the second surgery was recommended.
- In January 1995, Dr. Zoller advised Shawnee’s insurer that he had changed his view and believed Hamilton should have been considered unable to work for the entire period since his earlier release.
- Hamilton then filed a change-in-condition application seeking temporary total disability benefits retroactive to September 1993.
- A deputy commissioner ruled that Hamilton’s benefits should be suspended until she complied with her doctors’ instructions (including quitting smoking) so she could undergo the recommended surgery.
- The full Workers’ Compensation Commission reversed the deputy commissioner and awarded benefits; Shawnee appealed to the Court of Appeals of Virginia.

## Issues

1. Whether Hamilton’s continued smoking—when her physicians required complete smoking cessation (and weight loss) before performing recommended surgery—constituted an unjustified refusal of medical services allowing suspension of benefits under Va. Code § 65.2-603(B).
2. Whether Hamilton unjustifiably refused suitable selective employment when she declined the employer’s physician-approved modified cashier position.

## Decision

- The Court of Appeals of Virginia (panel) reversed the Commission’s award of benefits.
- The court held that, because the recommended surgery could not be performed unless Hamilton stopped smoking, her failure to quit smoking amounted to a refusal of necessary medical services under Va. Code § 65.2-603(B), and the refusal was unjustified on the record.
- The court also concluded the employer was entitled to relief based on Hamilton’s refusal of the offered selective employment.

## Legal Principles

- Under Va. Code § 65.2-603(B), workers’ compensation benefits may be suspended when a claimant unjustifiably refuses medical services furnished by the employer that are required for treatment of the compensable condition.
- A claimant can “refuse” medical care not only by declining a recommended procedure outright, but also by failing to meet physician-imposed conditions that must be satisfied before the procedure will be performed, when that failure prevents the treatment from occurring.
- When medical evidence shows a recommended surgery is conditioned on complete smoking cessation, continued smoking may be treated as a decision not to undergo that treatment for purposes of § 65.2-603(B).
- A claimant who is released to light-duty work generally must accept suitable selective employment within medical restrictions; an unjustified refusal can suspend or bar ongoing wage-loss benefits.

## Conclusion

In Shawnee Management Corp. v. Hamilton, the Court of Appeals reversed the Commission and held that Hamilton’s continued smoking, which kept her from obtaining physician-recommended surgery conditioned on smoking cessation (and weight loss), constituted an unjustified refusal of medical services under Va. Code § 65.2-603(B), and the employer was also entitled to relief based on her refusal of physician-approved selective employment.


Shawnee Management Corp. v. Hamilton, 480 S.E.2d 773 (1997)