West Virginia Record

Thursday, April 9, 2020

Supreme Court says hernia surgery isn't part of claim

State Supreme Court

By Kyla Asbury | Mar 23, 2020

Wvschero

CHARLESTON — The West Virginia Supreme Court of Appeals ruled that the Workers' Compensation Board of Review rightfully denied a claim to pay for hernia repair surgery.

Derrick Williams, Charleston police officer, appealed a decision by the board that denied payment for a hernia repair surgery, according to the memorandum decision.

The claims administrator denied the claim and the Workers’ Compensation Office of Judges reversed the claims administrator’s decision and authorized payment. 

The Board of Review then reversed and vacated the decision of the Office of Judges and reinstated the order of the claims administrator.

Williams completed an accident report in 2016 after he sustained a small laceration on his left elbow while chasing a suspect through a house. He was provided first aid and released to return to work on with no modifications to his duty that same day. However, nine days later, he went to Thomas Memorial Hospital Surgical Associates with pain in his right groin for about a month and he was scheduled for hernia repair surgery.

Williams underwent hernia repair surgery on Nov. 2, 2016, and, after surgery, he missed six weeks of work.

By letter dated Nov. 14, 2016, the claims administrator requested that Williams complete a Report of Injury form with regard to the Oct. 17, 2016, incident, which he failed to submit to the claims administrator.

Thomas Memorial Hospital subsequently submitted billing for the cost of the hernia repair, for which the claims administrator denied, citing that it was not related to the event on Oct. 17, 2016.

"After review, we agree with the decision of the Board of Review," the decision stated. "The initial incident report and treatment records indicate that Mr. Williams sustained a laceration to his left elbow while working, not a hernia. The report of hernia symptoms existing in the weeks prior to the elbow laceration incident and the reporting that Mr. Williams had no known event causing his symptoms support the Board of Review’s decision that he failed to establish that the hernia occurred in the course of and resulting from his employment."

The court found that the decision of the board was not in violation of provisions or laws and is affirmed.

West Virginia Supreme Court of Appeals case number: 19-0184

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West Virginia Supreme Court of Appeals