One of the most common issues that come up in West Virginia workers’ compensation cases is the question of whether a certain injury was caused by an accident on the job or is the result of a preexisting condition. Although further testing would often make it easier to answer this question, a worker may have to go out of his own pocket – or rely on his own medical insurance – to cover those tests. A recent case out of West Virginia’s Supreme Court is an example of how administrators and courts look at a preexisting condition. It also makes clear that requests for further testing must be backed by clear medical evidence in order for the workers’ compensation system to pick up the tab.
Mr. Tully was working as a pizza delivery driver for Gino’s when he was injured in a rear-end car accident in September 2012. He suffered a neck sprain – which was deemed covered under the state workers’ compensation program – and was cleared to return to work with modified duties. Although Tully reported experiencing spasms, a buzzing sensation, and tunnel vision, a doctor ultimately determined that these symptoms stemmed from his history of chronic neck and back pain and weren’t related to the accident. Tully had previously injured his head and neck during a fall three years earlier.
Based on the doctor’s findings, a claims administrator concluded that Tully wasn’t entitled to additional benefits for temporary total disability or permanent partial disability. The administrator denied Tully’s request for a cervical MRI and follow-up appointments. The Workers’ Compensation Office of Judges later reversed the decision in part, however, finding that Tully should have been permitted to undergo the MRI and follow-up appointments. Despite his history of neck and back problems, the Office said he was entitled to further testing to determine whether the accident had made his existing injuries worse.
Then, the West Virginia Workers’ Compensation Board of Review stepped in. Reversing the Office of Judges’ decision, the Board said there was no medical evidence recommending the cervical MRI. Instead, the Board found that the Office had inappropriately substituted its judgment for that of the medical professionals who examined Tully. Those doctors conclusively determined that Tully hadn’t suffered a compensable injury, according to the Board.
The West Virginia Supreme Court affirmed the decision on further appeal. The Court rejected Tully’s argument that his claim shouldn’t be evaluated until he reached maximum medical improvement. It agreed with the Board that there was no evidence to justify the MRI. “There is no physician of record that stated that a cervical MRI was necessary for the compensable injury,” the Court said. “It is therefore impossible to know why the cervical MRI was requested so it was properly denied.” As a result, the Court said the Board didn’t err in determining that Tully didn’t have a compensable claim.
It’s important for an injured worker to understand that the law puts the burden on you to prove that you’ve sustained a compensable injury on the job in order to be eligible for worker’s compensation benefits. If you or a loved one has been injured at work, the West Virginia back injury lawyers at the Wolfe Law Firm can help. Call us at 1-877-637-5756 or contact us online for a free consultation.
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