Worker's ongoing use of narcotic medication not reasonable, necessary
Case name: Logsdon v. Lear Corp., No. 2012-CA-000715-WC (Ky. Ct. App. 03/08/13, unpublished).
Ruling: In an unpublished decision, the Kentucky Court of Appeals held that a worker's ongoing use of narcotic pain medication was not reasonable and necessary treatment, while his epidural steroid injections were reasonable, necessary, and related to his work injury.
What it means: In Kentucky, a finding that medical benefits are reasonable and necessary does not mean that they remain so forever.
Summary: A worker suffered a low back injury while working. The parties settled his claim. Later, the worker filed a medical fee dispute alleging that the employer refused to pay for epidural steroid and narcotic pain medication recommended by his doctors. The administrative law judge found that the injections and medication were reasonable, necessary, and related to the work injury. The employer subsequently filed a medical fee dispute arguing that the ongoing injections and narcotic medication use were not reasonable, necessary, or related to his back injury. The Kentucky Court of Appeals held that the medication was not reasonable and necessary treatment, but the injections were reasonable, necessary, and related to his work injury.
The court explained that although there was contradictory evidence from doctors regarding whether the narcotic pain medication was reasonable or necessary, the medication use was unreasonable and unnecessary treatment. The court sympathized with the worker's "apparent frustration" that the opinion differed from the ALJ's previous opinion with regard to the use of medication. The court explained that a prior finding that medical benefits are reasonable and necessary does not mean that they remain so forever. Medical treatment can change over time. The court said that nothing prevents an employer from repeatedly raising the issue of reasonableness and necessity. However, nothing prevents an ALJ from sanctioning an employer that abuses the privilege.
The court found that the worker's consistent complaints of back and leg pain were sufficient to support an inference of current work-relatedness. The court found the injections were related to his injury and compensable.
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June 17, 2013
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