Its fair to say that this is well established point of law in Workers’ Compensation, therefore the fact pattern should not one that is heavily litigated.  However, whenever a new adjuster  looks at the situation, the response is disbelief.

I am referring to the recommendation of a diagnostic test (an MRI, X-Ray, Cat Scan, etc.) by an authorized doctor for a body part, injury, or condition that does not seem related to the compensable accident.  A lot of times I will get a call from an adjuster asking me if they should authorize a diagnostic test that is recommended by an authorized treater for a body part that Claimant did not report as an injury.   Many of those adjusters are surprised when I tell them they have to authorize it.  

And, I don’t blame them for that reaction.

The natural reaction to seeing a prescription for these tests is, “this isn’t my compensable body part.  I’m denying it.”  But, the First DCA views this differently.  They give the authorized doctor leeway to conduct their treatment.   Since a diagnostic test is used to rule out any compensable conditions, the Court views the request as part and parcel of compensable treatment even if the test reveals a non-compensable injury.  This principle of law has been around since almost 1981, but the knee jerk reaction to deny the request is so natural and recurring the First DCA always ends up revisiting the issue.

This occurred just yesterday in Chance v. Polk County Schools.  Claimant received multiple injuries to multiple body parts from two different accidents.  A problem of merging occurred, that is, it was very difficult to establish where Claimant’s old injuries ended and her new injuries begin.  Her authorized orthopedic wanted an MRI of Claimant’s right shoulder to properly diagnose this merger but the E/C denied the test.  The JCC agreed with the E/C because there was no evidence that the major contributing cause for the need of a shoulder MRI was the compensable accident.  The problem with this ruling was that the ortho needed the MRI so he could determine major contributing cause.  Without the MRI, his diagnosis was incomplete.

So, like in the many cases before Chance, the First DCA reversed the JCC’s order and remanded the case to grant authorization of the shoulder MRI. 

My advice to adjusters remains the same: even though the diagnostic test may be for a non-compensable injury/condition/body part, you still have to authorize the test.   To fight it would be a waste your litigation resources. 

Now, if that test comes up positive, then you can look into denying care if the authorized doctor (or a peer review or IME) believes the positive result is not related to the compensable accident. 

Advertisements