CHARLESTON — The West Virginia Supreme Court of Appeals sided with the Workers' Compensation Board of Review in an appeal in which an Ohio Power Company employee argued he needed additional therapy that was not approved by the claims administrator.
Jay E. Clegg was employed by Ohio Power Company and suffered from bilateral carpal tunnel syndrome and bilateral ulnar nerve lesions as the result of working many years of repetitive motion work for the company, according to a Nov. 1 decision by the state Supreme Court.
The appeal involved if Clegg was entitled to hand therapy, which was requested by his treating physician due to pain.
The claims administrator denied Clegg’s request for occupational therapy in an order dated Jan. 16, 2018, the decision states. The Workers’ Compensation Office of Judges reversed the claims administrator’s decision and approved hand therapy for Clegg three months later.
In the Board of Review’s final order on Sept. 24, 2018, it reversed and vacated the April 17, 2018, order of the Office of Judges and reinstated the claims administrator’s decision. The appeal followed.
Clegg was seen for an independent medical evaluation in 2017 and the physcian determined Clegg had reached his maximum degree of medical improvement. The claims administrator then denied the request for hand therapy.
"The Office of Judges reversed the claims administrator’s decision and approved hand therapy on April 17, 2018," the decision states. "In its Order, the Office of Judges concluded that it was more likely than not that Mr. Clegg’s current hand issues were related to the 2008 compensable injury and noted, '[e]ven if the petitioner has non-compensable issues like aging, treatment does not need to be solely for the compensable condition when the same body part is involved.'"
Ohio Power Company appealed and then the Board of Review reversed the decision of the Office of Judges and reinstated the original denial of hand therapy.
"On appeal, Mr. Clegg argues that the claims administrator is required to provide medically necessary and reasonably required medical treatment pursuant to West Virginia Code § 23-4-3 (2019) and West Virginia Code of State Rules § 85-20 (2006)," the decision states.
After review, the Supreme Court agreed with the Board of Review.
"The Board of Review correctly determined that the evidence does not establish that Mr. Clegg’s need for bilateral upper extremity hand therapy, over eight years after he last worked, is related to his compensable injury," the decision stated.
The court found that the decision of the Board of Review was not in clear violation of any constitutional or statutory provision. It also found the Board's decision was not the result of erroneous conclusions of law.
West Virginia Supreme Court of Appeals Case number: 18-0942
