What Do You Think: Can QuikTrip Worker Get Spinal Cord Stimulator as Benefit?

01 Mar, 2024 Chris Parker

                               

Tulsa, OK (WorkersCompensation.com). In Oklahoma, an injured employee who received benefits can obtain further treatment as “continued medical maintenance.” The hurdles for obtaining CMM have changed over the years, as illustrated by a case involving an employee who hurt his back while working at QuikTrip.

The employee injured himself at work in 2012 and received workers’ compensation benefits. The order issued by the Workers' Compensation Court of Existing Claims provided in part that the employer would provide him “reasonable and necessary” continued medical maintenance for pain management.

The claimant’s pain continued despite his doctor’s efforts, including the prescribing of various medications, to manage his pain. Concluding that the claimant had reached maximum medical improvement, the doctor recommended placement of a spinal cord stimulator.

In 2022, the claimant sought authorization from the Workers' Compensation Court for placement of the device as CMM. The court denied the request because the claimant didn’t demonstrate a change of condition for the worse.

Under Oklahoma statutory law, "continuing medical maintenance" means medical treatment that is reasonable and necessary to maintain a claimant's condition resulting from the compensable injury or illness after reaching maximum medical improvement.

In addition, the law provides that a court can’t award CMM unless it was recommended by a treating doctor at the time the claimant reached maximum medical improvement.

Did Workers’ Compensation Court correctly deny authorization for a spinal cord stimulator?
A. No. The doctor recommended the device after the claimant reached maximum medical improvement.
B. Yes. The claimant didn’t demonstrate that his condition had changed for the worse.

If you selected A, you agreed with the appeals court in Prewitt v. QuikTrip Corp., Case No. 120960 (Okla. Ct. App. 02/15/24), which held that the lower court incorrectly denied authorization for placement of the device.

The appeals court pointed out that prior to 2010, there was no statutory definition of CMM. Further,  the state Supreme Court had held in some cases that a claimant is not normally entitled to additional medical treatment beyond what was originally ordered unless he establishes a change of condition for the worse.

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That changed in 2011, however, with the new statutory definition of CMM.  The court noted that the definition of CMM does not include a prerequisite that a worker demonstrate a changed condition. Rather, it only requires the requested medical treatment be "reasonable and necessary" to maintain a claimant's condition resulting from the compensable injury and that the CMM be authorized in advance of the treatment.

Here, the doctor recommended the new treatment at the time that the claimant reached maximum medical improvement. The lower court therefore erred in holding that claimant was required to demonstrate a change of condition for the worse.

The appeals court reversed and remanded the case for a determination of whether a spinal cord stimulator was reasonable and necessary to maintain the claimant's condition.


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