Treatment that simply manages symptoms or pain is eligible for a worker's compensation claim, a Pennsylvania court has ruled.
The ruling from the three-judge Pennsylvania Commonwealth Court reverses a decision by a worker's compensation judge, according to the Legal Intelligencer, a legal affairs journal.
The claimant, Jonathan Green, injured his lower back on Nov. 18, 1993, while working for Trafalgar House & St. Paul Fire & Marine Insurance. He began receiving benefits in January 1994, pursuant to a notice of compensation payable.
As part of his medical treatment, Green received pain and anti-inflammatory medications, physical therapy, aqua therapy, moist heat, electrical stimulation, ultrasound, and osteopathic manipulation, the commonwealth court observed.
The employer filed a utilization review petition requesting a review of the reasonableness and necessity of the treatment rendered to Green by his provider, Edward E. James, D.O.
The utilization review organization initially found that the treatment was reasonable and necessary only for three months, but James asked for reconsideration. On reconsideration, the URO deemed the treatment reasonable and necessary for six months.
But James remained dissatisfied with the URO's determination and filed a review petition. A worker's' compensation judge denied the petition, finding that Green did not prove that ongoing physical therapy was needed to treat his work injury.
The case eventually landed before the commonwealth court, led by President Judge Joseph T. Doyle.
In the opinion on the employer's appeal to the Commonwealth Court, Doyle said that there is no "bright-line standard" to use when analyzing whether treatment is reasonable or necessary but that there are guidelines by which the court abides.
He cited two 1999 cases where the court had made similar rulings.
"The standard, or guideline, enunciated in the above cases is that medical treatment may be reasonable and necessary even if the treatment does not cure the underlying injury, so long as it acts to relieve the pain and treats the symptomatology, i.e., if it is palliative in nature," Doyle said.
None of the witnesses disputed the fact that James' treatment was not expected to cure Green's soft-tissue injuries, Doyle said, so the question was whether Green was still feeling pain and whether James' treatment was relieving that pain.
Green testified that he had relief from pain for a few days after treating with James.
That was enough evidence to allow Green to continue to receive benefits, Doyle said.
To view the Legal Intelligencer article at Law.com, click here.
