Case name: Joy v. Department of Labor and Industries, No. 42118-6-II (Wash. Ct. App. 09/11/12).
Ruling: The Washington Court of Appeals held that a worker was not authorized to receive treatment by a spinal cord stimulator.
What it means: In Washington, the Department of Labor and Industries cannot authorize treatment by a spinal cord stimulator as necessary and proper medical treatment.
Summary: A worker suffered a neck injury at work that caused chronic cervical neuropathic pain. The Department of Labor and Industries allowed her workers' compensation claim and provided medical treatment, including physical therapy, cortisone injections, surgeries, and pain medications. She requested a spinal cord stimulator as necessary and proper medical treatment for her injury. The industrial insurance medical advisory committee, which advises the department on coverage decisions, had determined that coverage should not be allowed for spinal cord stimulation based on a study showing that it had the potential for harm. The health technology clinical committee also found that spinal cord stimulation was "less safe than alternatives, is an invasive procedure, and has many adverse events." The Washington Court of Appeals held that the worker was not entitled to a spinal cord stimulator.
The court explained that when the clinical committee makes a coverage determination for a particular health technology, a participating agency such as the department must comply with the determination. The court rejected the worker's argument to make a "necessary and proper" determination and order the department to authorize the treatment. After the clinical committee determines that a health technology will not be covered, that health technology is no longer subject to a determination in the case of one individual as to whether it is proper and necessary treatment. The court also said that the worker's argument would lead to absurd results.
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November 19, 2012
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