Surgery allowed for disk protrusion despite benefits to unrelated stenosis

In Ohio, a worker's request for surgery required for an allowed condition cannot be denied just because the surgery would also treat a condition not related to the work injury.

Case name: State of Ohio ex rel. Cassens Transport Co. v. Industrial Commission of Ohio, No. 11AP-680 (Ohio Ct. App. 10/18/12).

Ruling: The Ohio Court of Appeals held that a worker's surgery for decompression and fusion treatment was authorized.

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What it means: In Ohio, a worker's request for surgery required for an allowed condition cannot be denied just because the surgery would also treat a condition not related to the work injury.

Summary: A worker was injured in the course of and arising from his employment. His workers' compensation claim was allowed for disk protrusions. The worker filed a request for surgery for decompression and fusion treatment. The employer argued that the surgery was not medically necessary or reasonably related to the allowed conditions in the claim and that the surgery was related to his spinal stenosis. The Ohio Court of Appeals held that the surgery was authorized.

The court pointed out that medical reports and an MRI established a connection between the allowed condition and the worker's need for surgery. One doctor explained that the disk herniations directly contributed to and created the spinal stenosis. The request for surgery completed by another doctor related the need for surgery with the worker's disk protrusions. The court found that the requested surgery was necessary to treat the allowed disk protrusions even though it also related to the spinal stenosis.

The court said that the mere presence of spinal stenosis did not negate the medical evidence establishing that the surgery would treat the allowed disk protrusions. Also, the court said that the existence of a contributing nonallowed condition is not a legitimate reason for refusing to pay for medical treatment independently required for an allowed condition.

Read more at the WorkersComp Forum homepage.

January 10, 2013

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