Medical Benefits—Claimant must prove the specific treatment is compensable not just the body or diagnosis.

Claimant sustained a low back injury in 1998 and underwent multiple surgeries between 2000 and 2013 including a spinal cord stimulator.  Claimant was eventually found permanently and totally disabled in 2017 and continued with maintenance medical treatment.  In 2018 claimant underwent two surgeries on his right foot for removal of the toenails on two toes due to fungus, hammertoe, and keratosis and a toe amputation due to a bone infection.  In January of 2020 claimant underwent a third procedure on his right foot that included the partial amputation of another toe as a result of acute bone infection.  Claimant filed an application seeking payment for all three procedures including reimbursement for his out of pocket expenses.  In February of 2020, claimant’s treating surgeon authored a letter stating that the surgeries from 2018 and 2020 were related to a longstanding neuropathy claimant had in his right foot as a result of the work injury and therefore were related to the 1998 injury.  Respondents obtained an opinion from Dr. Burris who opined that while claimant did have a lower extremity neuropathy, the medical records did not support a causal relationship to the work injury. He also opined that claimant’s surgeries were due to his underlying comorbid conditions.  After hearing the ALJ found that while claimant did have a work-related neuropathy in the right foot, the medical records did not support a causal relationship to the neuropathy or otherwise to the work injury.  Rather, the records clearly established that claimant’s 2018 and 2020 surgeries were the result of personal medical issues.  He therefore denied claimant’s request for payment of the surgeries and reimbursement of out of pocket expenses.

Larry Hendrix v. Draeger National a/k/a Draeger Safety, Inc., W.C. 4-392-153-003

Want to know more?  Contact Michelle Prince at mprince@pollartmiller.com or 877-259-5693.

August 2020 Newsletter

2020-09-02T16:57:47-06:00