Agreement, pre-authorization secure benefits for back surgery
Case name: Lane-Walter v. State of Wyoming, No. S-10-0087 (Wyo. 03/24/11).
The Wyoming Supreme Court held that a worker's surgical implantation of a device in her back was reasonable and necessary medical treatment for her work-related injury, entitling her to compensation.
What it means: In Wyoming, when a worker enters into a settlement agreement with the Safety and Compensation Division wherein the division agrees to pay for all reasonable and necessary medical treatment, and the division pre-authorizes treatment, the division has the burden of proving medical treatment is not reasonable and necessary.
A roof bolter operator in an underground mine injured her back while working. She never returned to work after her injury. She underwent several surgical procedures that exacerbated her condition. Thirteen years after her injury, she entered into a settlement agreement with the Safety and Compensation Division, in which the division agreed to pay for medical treatments related to the work injury. The operator later sought to have a surgical implantation of a device in her back. The division told the operator the surgery was pre-authorized but denied benefits for the surgery. The operator underwent the surgery, which relieved some of her pain. The Wyoming Supreme Court held that the operator was entitled to benefits for the surgery.
The court said that after surgery, the operator continued to use many of the same prescription medications she used before surgery, but at a reduced level. The division treated her continued use of medications as proof that the surgery was not reasonable or necessary, which the court said was incorrect.
The court also explained that a doctor's independent medical examination was "based upon dated materials that he summarized inaccurately and in a manner that shed the worst possible light" on the operator. The court was bewildered that the operator was considered a dishonest witness because she claimed numbness in her toes was improved by the surgery, which the doctor said was not possible.
A concurring judge disagreed with the majority's placement of the burden of proof on the division, stating that it would cause problems in future cases.
Read more at the WorkersComp Forum homepage.
May 12, 2011
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