CHARLESTON — The West Virginia Supreme Court of Appeals ruled that an injured worker's claim was properly ruled upon by the Workers' Compensation Board of Review.
Charles Campbell, who was employed by Debrich LLC, appealed the decision of the board of review, according to a memorandum decision by the West Virginia Supreme Court of Appeals.
"The issue on appeal is whether Mr. Campbell is entitled to the requested treatment in the claim," the decision states. "On May 3, 2019, the claims administrator issued an Order denying a request for a referral for an EMG of the left leg and a request for a referral to an orthopedic surgeon for an evaluation of his left foot/ankle."
Subsequently, the claims administrator denied requests for medication on Sept. 26, 2019, and Dec. 18, 2019. On July 8, 2020, the Workers’ Compensation Office of Judges affirmed the claims administrator’s orders. This appeal arises from the Board of Review’s Nov. 4, 2020, order, in which the board affirmed the order of the Office of Judges.
Campbell, a truck driver, was injured in the course of his employment on Jan. 24, 2014. The Employees’ and Physicians’ Report of Injury indicated Campbell injured his left ankle when he stepped on a lump of coal at a river dock.
Dr. Prasadarao Mukkamala performed an Independent Medical Evaluation on Aug. 29, 2017, in which he diagnosed left distal fibula fracture and found that Campbell had reached maximum medical improvement. He assessed 4% impairment and opined that there was no evidence of complex regional pain syndrome.
Five months later, Dr. Bruce Guberman performed an Independent Medical Evaluation and assessed 2% impairment due to nerve damage and 9% due to range of motion restrictions. His combined total impairment rating was 11%.
The claims administrator denied several claims in 2018 and 2019, all of which Campbell protested.
"The Office of Judges also concluded that the authorization for the medications Belbuca and codeine were appropriately denied by the claims administrator because the treating physician failed to sufficiently explain why the guidelines of West Virginia Code of State Rules § 85-20-53.14 should not be followed," it states.
The Board of Review adopted the findings of fact and conclusions of law of the Office of Judges and affirmed the decision in an order dated Nov. 4, 2020.
"After review, we agree with the decision of the Office of Judges, as affirmed by the Board of Review," the court found. "While Mr. Campbell’s course of recovery from his compensable injury has not been optimal, the medical evidence of record in this claim fails to establish that the requested treatment is medically necessary or reasonably required to treat his compensable injury."
West Virginia Supreme Court of Appeals case number: 20-0948