CHARLESTON – The West Virginia Supreme Court of Appeals backed the West Virginia Workers' Compensation Board of Review approving a man's claim for worker's compensation over the protests of his employer, Murray American Energy.
Michael Keller injured his back and right shoulder at his job at Ohio County Coal Company in 2015. Dr. C. Clark Milton diagnosed him with thoracic strain and shoulder strain, and he filed a compensatory claim. Further exams showed he needed surgery, so he was sent to another physician to have the procedure done. A second surgery followed.
Despite the surgeries, Keller's shoulder did not improve. The surgeon eventually concluded that he might not be able to treat Keller further. Keller returned to consult with Milton as his range of motion decreased; Milton concluded that Keller had suffered a six-percent total loss of function and imposed restrictions on his range of activities.
With his shoulder still deteriorating, Keller sought a second opinion. That doctor prescribed a pain management evaluation, and Keller sought to amend his worker's compensation claim to include the evaluation. The claims administator asked Milton about the need for the evaluation, then denied Keller's application.
Keller objected. The Worker's Compensation Office of Judges backed the administrator's denial. Keller took his case to the Board of Review, which on July 14, 2018, overturned the Office of Judges' decision, saying Keller's evaluation should have been made part of his worker's compensation claim. Murray American Energy appealed that reversal.
The court of appeals sided with Keller.
"The record indicates that Dr. Milton did not believe that he could do any more for Mr. Keller and encouraged him to seek another opinion," the decision said.
Given Keller’s history, medical records and the preponderance of the evidence, the board did not err in concluding that the requested diagnoses are causally related to his compensable injury in this claim, the appeals court said. The board also did not err in finding that the evidence establishes that a pain management evaluation is medically necessary and reasonably required in the course of the treatment of Keller’s compensable injury.
"For the foregoing reasons, we find that the decision of the Board is not in clear violation of any constitutional or statutory provision, nor is it clearly the result of erroneous conclusions of law, nor is it so clearly wrong based upon the evidentiary record that even when all inferences are resolved in favor of the Board’s findings, reasoning and conclusions, there is insufficient support to sustain the decision," the Supreme Court decision stated.
West Virginia Supreme Court of Appeals case No.: 18-0740