CHARLESTON – The state Supreme Court has overruled the Workers’ Compensation Board of Review, finding that “the Board of Review is in clear violation of statutory provision” in denying a man the initial psychiatric consultation his physician recommended.
The memorandum opinion, with all justices concurring, was released on Dec. 7.
“This matter is remanded with directions to refer Mr. Haught for an initial psychiatric consultation and a determination of whether the psychiatric condition, if any, should be accepted as a compensable condition in Mr. Haught’s claim," the opinion says.
According to the opinion, Timothy G. Haught was treated by Dr. Keith Poole from at least February 2007 through July of 2009 in connection with a work-related injury he received while employed by United Construction Company.
At some point in Haught’s treatment, Dr. Poole “submitted an appropriate request for a psychiatric consultation” that the claims administrator denied to authorize.
Haught, appealed through the Workers’ Compensation administrative process.
In March 2010, the Workers’ Compensation Office of Judges affirmed the claims administrator’s denial, holding “there is no causal connection between Dr. Poole’s request for a psychiatric consultation and the compensable injuries.”
The Office of Judges noted that there was no mention of psychiatric symptoms in Dr. Poole’s notes up until July of 2009.
The Board of Review then reached the same conclusion, affirming the Office of Judges in issuing its order in September of 2010.
Having exhausted administrative remedies, Haught, through his attorney M. Jane Glauser, appealed to the state Supreme Court.
The Court cited its recent decision in Hale v. West Virginia Office of Insurance Commissioner, in which it held that there is a three-step process that must be undertaken when a claimant is seeking to add a psychiatric condition to a claim:
1) The treating physician refers the claimant to a psychiatrist for an initial consultation;
2) The psychiatrist makes a detailed report in accord with the West Virginia Code of State Rules; and
3) The claims administrator determines whether the condition should be added as a compensable injury on the claim.
“Mr. Haught was not afforded an initial psychiatric consultation as provided in West Virginia Code of State Rules," the opinion says. "(T)herefore, the Court holds that this matter shall be remanded for further proceedings consistent with the three-step process set forth in Hale.”