When Treatment May Be Directed Towards More Than One Condition

Recently, the Tenth District Court of Appeals (Franklin County), reaffirmed the concept that treatment in a workers' compensation claim may be approved, even if the treatment may be directed towards a non-allowed medical condition. In State ex rel. Cassens Transport Co. v. Indus. Comm., et al., 2012-Ohio-4829 (Oct. 18, 2012), the Court of Appeals concluded there was sufficient evidence before the Industrial Commission to reach a conclusion that the injured worker's request for spinal surgery was reasonably related to the allowed conditions in the claim. The injured worker had an allowance for "disc protrusions at L3-4 and L4-5." However, the claim was NOT allowed for "spinal stenosis at L3-4 and L4-5." The attending physician opined the injured worker's disc protrusions were directly contributing to and causing the spinal stenosis, i.e. the narrowing of the space for the exiting nerve roots. Although the claim was not allowed for the spinal stenosis, the Industrial Commission concluded the requested surgery was medically necessary and resonably related to the injured worker's allowed condition of disc protrusions. The Court of Appeals agreed, concluding 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." See, also, State ex rel. Jackson Tube Serv., Inc. v. Indus. Comm., 99 Ohio St.3d 1, 2003-Ohio-2259, quoting State ex rel. Griffith v. Indus. Comm., 87 Ohio St.3d 154, 156 (1999).

For those injured workers who have conditions not recognized in their claim, but the allowed condition provides an independent basis for the treatment, the treatment should be approved. Ideally, the injured worker should pursue a request for the further allowance of the other conditions (if they are related to the accident) before requesting treatment or compensation; however, there may be some circumstances where the injured worker is not able to wait for the administrative processing of a request for further conditions, such as in a case where surgery is needed immediately. In those cases where treatment is needed immediately, the Cassens case supports the concept that the treatment should be approved as long as the allowed conditions in the claim provide an independent basis for the treatment.

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