In an interesting case, the Oregon Workers’ Compensation Board found that an insurance carrier’s acceptance of “low back pain” encompassed acceptance of an L4-5 disc herniation.
The injured worker suffered an on-the-job injury, and had undergone surgery at L4-5, which is the area between the fourth and fifth lower back bones. There was additional surgery over the next 25 years, and all but one of the surgeries were processed under the claim.
Eventually, the Claimant’s doctor proposed a seventh surgery for the L2-3 and L3-4 discs. These are one of the structures that make up the joint between the second and third lower back bone, and the third and fourth lower back bone. The insurance company denied this request, arguing that prior settlements and agreements had referred to the accepted condition as a "low back strain," and that because the need for a surgery was not caused by a strain, the insurance company is not responsible to treat the condition.
However, the Board disagreed, citing Oregon Supreme Court and Court of Appeal case law that requires insurance companies to cover treatment for any symptoms it accepts, regardless of the underlying cause.
Our firm has worked with several clients who have long time injuries requiring extensive medical care. If you have an issue regarding a long accepted claim, and are having trouble getting medical care, call us at 503-325-8600. We can review your claims file, and determine your options. We only get paid if we are instrumental in obtaining benefits.