Worker's neck strain did not necessitate surgery, pain medications

In Kentucky, in a post-settlement medical reopening, the worker must prove causation and the employer must prove that the contested treatment was unreasonable and unnecessary for a work-related injury.

Case name: Robins v. Claire's Stores, Inc., No. 2010-SC-000286-WC (Ky. 01/20/11, unpublished).

Ruling: In an unpublished decision, the Kentucky Supreme Court held that an employer was not required to pay unpaid medical expenses related to a worker's neck injury and it had not acted in bad faith by refusing to pay.

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What it means: In Kentucky, in a post-settlement medical reopening, the worker must prove causation and the employer must prove that the contested treatment was unreasonable and unnecessary for a work-related injury.

Summary: A worker injured her neck and right shoulder when she attempted to catch a computer that fell from a counter at work. She also suffered from related psychological problems. Shortly after the accident, her doctor treated her for neck pain, prescribing physical therapy, various pain medications, and periodic injections. The doctor also performed a diskectomy and fusion. The parties agreed to a settlement in which the employer would pay for all past, present, and future medical expenses. Later, the employer requested a doctor to conduct a medical records review. The doctor concluded that the worker had received excessive medical treatment and physical therapy. The employer sought to reopen the case, contesting liability for unpaid and future medical expenses. The Kentucky Supreme Court held that the employer was not required to pay unpaid medical expenses related to the worker's neck injury, and the employer had not acted in bad faith by refusing to pay these expenses.

The court said that medical opinions established that the worker had no neurological defects. Her work-related neck injury was a cervical strain, which required no further medical treatment. Surgery and treatment to the worker's neck addressed nonwork-related degenerative changes rather than the work-related injury. The court said that evidence that the worker's neck pain could have resulted from scar tissue or surgery did not support a finding that pain medication was compensable because the surgery itself was nonwork-related.

The worker asserted that the employer acted in bad faith in its decision to discontinue paying her medical bills. The court disagreed, stating that the employer had a reasonable basis for refusing to pay for the disputed treatment voluntarily. The employer's doctor thought the work-related cervical strain required no further treatment and that the worker received excessive treatment.

Read more at the WorkersComp Forum homepage.

March 10, 2011

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