CHARLESTON - A coal truck driver who suffered head, back and other bodily injuries was properly denied access to Xanax and Opana because his doctor failed to provide sufficient evidence that the medications were “reasonably required treatment for the compensable injury,” the state Supreme Court has ruled.
The court’s Oct. 4 ruling affirmed a decision by the state Workers’ Compensation Board of Review to deny Jeff Jones access to the medication. Jones, a coal truck driver for D&J Trucking, Inc., was injured when the brakes of his truck gave out causing him to hit another truck flipping his own vehicle over onto the driver’s side on May 13, 2009.
In his original Workers’ Compensation claim, the board held he was compensable for a lumbar sprain and then later amended to compensate him for a displaced lumbar vertebral disc and fracture of the lumbar vertebra.
In December 2010, a doctor prescribed the regulated pain medications to Jones. However, a claim administrator denied the prescription because “the use of the narcotics exceeded the West Virginia Code of State Rules § 85-20 (2006) treatment guidelines, and the evidence shows that Mr. Jones had been taking at least one narcotic prior to the compensable injury,” the high court wrote in its decision.
The administrator decided that Opana and Xanax were not medically necessary and reasonable to treat Jones.
Jones appealed the decision to the Board of Review, which affirmed the administrator’s judgment.
Jones then appealed to the state Supreme Court. In the majority opinion affirming the board’s ruling, the court wrote that Jones failed to submit sufficient evidence to prove “this is an extraordinary circumstance under West Virginia Code of State Rules §85-20-4.1 because there is little or no objective evidence that this medication has rendered effective relief of symptoms in the past.”
Chief Justice Brent Benjamin affirmed the board’s decision and was joined by Justices Robin Davis and Allen Loughry II. Justices Margaret Workman and Menis Ketchum dissented.