Maintenance Medical Benefits

In Major, the Panel affirmed the ALJ’s decision to deny the Respondent’s request to terminate ongoing maintenance medical benefits.

Here, this matter went to hearing on whether the Claimant’s ongoing medical treatment (e.g., medication refills, epidural steroid injects, etc.) was causally related to his work-related March 3, 2000 injury, and whether the treatment regimen prescribed by his authorized treating physician (ATP), Dr. Finn, was reasonably necessary.

After the hearing, the ALJ found that the Claimant sustained an admitted industrial injury on March 3, 2000, due to a large explosion while checking a natural gas leak. He was thrown approximately 20-25 feet, and a wall collapsed on top of him. As a result of the accident, the Claimant injured his left shoulder, low back, and bilateral elbows, and sustained hearing loss.

After undergoing conservative treatment, Dr. Finn placed Claimant at MMI on March 19, 2002 with an 11% whole person impairment rating. The Respondents filed a FAL admitting for reasonable, necessary, and related Grover medical benefits. Grover medical benefits are future medical benefits that are reasonably necessary to maintaining the Claimant’s health after the Claimant reached MMI.

Since that point, the Claimant’s treatment has been focused on his low back, mainly in the form of medication to alleviate his pain.

At the Respondents’ request, the Claimant underwent an IME with Dr. Beatty in May 2016.  Dr. Beatty opined that Claimant’s ongoing symptoms were not casually related to the original March 3, 2000 industrial injury, and therefore, his need for ongoing treatment was not related to the industrial injury.

After receiving Dr. Beatty’s report, the Respondents denied the Claimant’s request for additional injections and narcotic medication. Consequently, the Claimant filed an application for hearing.

Dr. Finn testimony was admitted at hearing. He opined that ongoing care, including opioid medication, was reasonable, necessary and related to the 2000 injury.   The ALJ agreed and ordered the Respondents liable for all reasonably necessary medical treatment related to the industrial injury.

The Respondents appealed, arguing that the ALJ erred because the ALJ’s order is not supported by substantial evidence, and that the “overwhelming evidence” instead supports the conclusion that the Claimant’s current low back condition is caused by the natural progression of his preexisting and unrelated degenerative low back issues. However, the Panel disagreed.

The ICAO affirmed the ALJ’s order because the Panel did not believe the ALJ abused its discretion in crediting the evidence from Dr. Finn over that from Dr. Beatty. It was the ALJ’s “sole prerogative” to credit one physician’s testimony over another when there are conflicting opinions.

Major v. Xcel Energy, W.C. No. 4-493-994-04 (ICAO Jan. 23, 2018).

Would you like to know more? Contact Christin Bechmann at cbechmann@pollartmiller.com or 720.488.9586.

 

 

From the February 2018 Pollart Miller Newsletter

2019-01-29T09:20:03+00:00