CHARLESTON – The West Virginia Supreme Court of Appeals has issued a decision that a requested surgery is not medically related to the compensable injury an employee sustained in a car accident.

“In workers’ compensation law, a claimant is entitled to medically related and reasonably required treatment as long as the treatment is for an injury or disease sustained in the course of and resulting from employment,” the Nov. 7 decision states.

Tim Hollington was working for B E Aerospace when he was injured in a motor vehicle accident.

“We are asked to decide whether orthopedic surgery should be authorized,” the decision states. “After a thorough review of the evidence, we find that the requested surgery is not medically related or reasonably required for the compensable injury.”

Hollington was treated by Dr. Benjamin Moorehead for a work injury. He reported pain in his left hip and a burning sensation in the thigh. He reported that driving long distances caused increased hip pain.

The impression was left hip/pelvic strain involving the left SI joint, and Moorehead referred Hollington for physical therapy.

Hollington received physical therapy for two months from Dynamic Physical Therapy and he initially presented with symptoms consistent with sacroiliac dysfunction and thoracic sprain/strain following a work-related motor vehicle accident.

 The diagnoses were listed as pain in pelvic region and thigh, osteitis condensans, and sprain of the sacroiliac region. The claim was held compensable for abrasions to the bilateral knees and a closed head injury. Hollington was not found to be eligible for temporary total disability benefits as he was disabled for less than three days.

Hollington testified in a deposition that he was driving a truck, took a turn too fast and flipped the truck.

Hollington had pain in the left side of his body including the shoulder, ribs, and hip. He stated that he was improving with treatment but treatment was then stopped. Since therapy ended, he has experienced increased pain in his ribs and a burning sensation from his lower back to his left hip.

Hollington then completed a reopening form for temporary total disability benefits and Moorehead listed the diagnosis as left hip sprain with pain and burning over the hip and thigh. He recommended an MRI and physical therapy.

Hollington could return to work for sedentary work only. Moorehead then stated that he was temporarily and totally disabled from April 28, 2014, until Aug. 31, 2015.

Dr Sushil Sethi performed an independent medical evaluation in which he opined that Hollington has had more than sufficient physical therapy. He stated that Moorehead did not provide any examination findings and there were no specific objective physical findings that would require physical therapy.

On examination, Sethi found no residuals from the compensable injury that would require physical therapy. There were also no new and distinct findings that would require temporary total disability from June 22, 2014, through Aug. 31, 2015. The compensable conditions would have resolved prior to June 22, 2014.

Sethi determined Hollington had reached maximum medical improvement and assessed 3 percent impairment.

The claims administrator denied a request for orthopedic surgery. The Office of Judges affirmed the decision.

The Office of Judges found that the compensable conditions in the claim are closed head injury, bilateral knee abrasions and hip sprain/strain, none of which warrant surgery.

Furthermore, Hollington was found to be at maximum medical improvement by Sethi.

The Office of Judges therefore concluded that a preponderance of the evidence failed to show that the requested surgery is medically related or reasonably necessary. The Board of Review adopted the findings of fact and conclusions of law of the Office of Judges and affirmed its Order.

“After review of the evidence of record and consideration of the parties’ arguments, we agree with the reasoning and conclusions of the Office of Judges as affirmed by the Board of Review,” the decision states. “The claim has been held compensable for abrasions, a hip sprain and a head injury, none of which require surgery.”

W.Va. Supreme Court of Appeals case number: 17-0164

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