Hospital's failure to provide care permits assistant to change doctors

In Virginia, an insurer's improper denial of further benefits constitutes a failure to provide medical care, which entitles a worker to seek out another doctor.

Case name: McIntyre v. DMHMRSAS Eastern State Hospital/Commonwealth of Virginia, No. 2361-10-1 (Va. Ct. App. 06/28/11, unpublished).

Ruling: In an unpublished decision, the Virginia Court of Appeals held that an assistant was entitled to medical costs because her change in physicians was authorized.

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What it means: In Virginia, an insurer's improper denial of further benefits constitutes a failure to provide medical care, which entitles a worker to seek out another doctor.

Summary: A certified nursing assistant for a hospital injured her ankle when she released the brake on a wheelchair and accidentally kicked the chair. The employer accepted the injury as compensable. An orthopedist opined that her injury was the result of a chronic condition. The assistant received a letter from the hospital stating that it would not make further payments on her claim. The assistant began treatment with another doctor, who opined that she had a trapped nerve in her ankle related to the work incident. The assistant sought temporary total disability benefits and reimbursement for medical bills for treatment by the second doctor. The Virginia Court of Appeals held that the assistant was entitled to medical costs because her change in doctors was authorized.

The court explained that an insurer's improper denial of further benefits constitutes a failure to provide medical care. A failure to provide medical care for a compensable injury entitled a worker to seek out another doctor. Here, the hospital's letter effectively terminated the worker's benefits, so the court said the assistant's treatment with the second doctor was not unauthorized.

The court pointed out that the letter referenced all of the assistant's symptoms. It did not allow any distinction between the condition for which she received workers' compensation and the condition for which her private insurance company would be responsible. The letter also questioned whether her condition was related to the original compensable injury.

Read more at the WorkersComp Forum homepage.

August 18, 2011

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