Worker fails to prove necessity for in-ground pool

In Florida, an examining psychiatrist's opinions regarding the psychiatric necessity for a pool at a worker's residence will hold little weight where no psychiatrist diagnosed him with a psychiatric condition.

Case name: Peluso v. City of Cape Coral, 18 FLWCLB 184 (Fla. JCC, Ft. Myers 2011).

Ruling: A Florida judge of compensation claims held that a worker failed to establish entitlement to a requested in-ground swimming pool.

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What it means: In Florida, an examining psychiatrist's opinions regarding the psychiatric necessity for an in-ground swimming pool at a worker's personal residence will hold little weight where no psychiatrist diagnosed him with a psychiatric condition.

Summary: A worker was exposed to raw sewage while working for a city. He developed a severe infection which resulted in amputation of both his legs below the knee. The city provided him with prosthetic devices, home modifications, a treadmill, a motor vehicle, and psychiatric medical care. His wife indicated to the treating physiatrist that she was thinking about an in-ground pool at their home. The doctor felt this would be beneficial and wrote a prescription for it.

The city offered the alternative of aquatic therapy at a facility with two indoor heated pools and authorized lifetime memberships to the facility for the worker and his wife. The worker subsequently filed a petition requesting an in-ground heated swimming pool at his personal residence based on the recommendation of his IME psychiatrist. The JCC denied the petition.

The worker relied on his IME psychiatrist to establish medical necessity, yet no psychiatrist diagnosed him with a psychiatric condition. The treating physiatrist opined that the pool memberships were a reasonable alternative to the at-home, in-ground pool and that the at-home, in-ground pool was not reasonably medically necessary. The JCC accepted this opinion and concluded that the worker did not establish entitlement to the requested pool.

Read more at the WorkersComp Forum homepage.

January 5, 2012

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