In this case, the injured worker sought injections for a cervical spine injury. The Employer denied that the proposed injections were a result of the accepted condition. The ALJ agreed with the Employer, and found that the proposed injections were not related to the accepted condition, and were therefore not compensable. The injured worker appealed.
After the decision at the hearings level, the Court of Appeals decided a case that clarified how a Judge should determine whether proposed medical treatment is “compensable.” The Court of Appeals ruled that the question is not whether not the proposed medical treatment is aimed that treating the accepted condition, but instead whether or not the proposed treatment is connected to the injury event. An example might be helpful.
When an insurance company accepts a workers’ compensation claim, it must define the medical condition that it is accepting responsibility for under the claim. However, the question is not whether not the on-the-job injury caused the specific medical condition, but instead, whether the on-the-job injury caused the need to treat the medical condition. This is a different issue. A worker might suffer an injury event at work that causes the need to treat long-standing arthritis. If the injured worker can show a strong enough connection between the work incident and the need to treat the arthritis, then the insurance company is responsible to treat that condition.
This case represents a fundamental shift and how insurance companies and Administrative Law Judges review these cases. In the past, there was a focus on whether an injury event caused a specific medical problem like a lumbar strain, lumbar disk herniation, or some other injury. Now, the question is whether the work injury event caused a need for medical care, regardless of what medical condition the physicians are treating.
If you have an ongoing claim, and are having trouble obtaining medical care, contact her office to discuss your claim. We can review your file, and let you know where you stand.