Medical Treatment

1. Reasonable and Necessary

The employer shall promptly provide for an injured employee such medical, surgical or other attendance or treatment, nurse and hospital service, medicine, crutches, and apparatus as may be necessary after the injury.
85 O.S. §14A1

Upon the receipt of notice that an employee has been injured, the employer has an obligation under the Workers' Compensation Act to provide that employee with reasonable and necessary medical treatment, and to commence temporary compensation in the event that the employee is disabled and unable to return to work for more than three (3) calendar days. It is not necessary for there to be any order of this Court directing the employer to provide these benefits.
85 O.S. Ch. 4 - App. - Rules of the Workers' Compensation Court 14A

"The question of whether medical treatment is necessary for an injured worker is a question of fact for determination by the trial tribunal." Iwunoh v. Maremont Corp., 1984 OK 8, 692 P.2d 548.

The medical and nursing care provided for in the statute "is such as will reasonably and seasonably tend to relieve and cure the injured employee from the effects of the injury," rehabilitate him "in order that he may return to the ranks of productive labor with normal capacity when possible, and when impossible to restore normal capacity the to the highest degree attainable" "together with temporary relief." McMurtry Bros. v. Angelo, 139 Okl. 236, 281 P. 964, 965 (1929). The purpose is to secure a prompt restoration. Mattingly v. State Ind. Court, Okl., 382 P.2d 125, 128 (1963). These cases emphasize that the treatment to be provided is that which is necessary.
Orrick Stone Company v. Jeffries, 1971 OK 116, 488 P.2d 1243.

Failure to provide medical treatment may result in sanctions against the employer or its insurance carrier. 85 O.S. Ch. 4 - App. - Rules of the Workers' Compensation Court 28E.

Although there is no published case in Oklahoma, weight-reduction or bariatric surgery has been approved in several states, including Indiana, as a necessary precursor to lumbar back surgery. Boston's Gourmet Pizza v. Childers.

2. Apparatus and Assistive Devices

The employer shall promptly provide for an injured employee such medical, surgical or other . . . apparatus as may be necessary after the injury.
85 O.S. §14A1

In the case of Phillips Petroleum Co. v. Carter, 1995 OK CIV APP 138, 914 P.2d 677, the trial court ordered employer to provide claimant with an under-vehicle wheelchair lift and related necessary equipment to transport the express mobility vehicle (motorized scooter) previously provided to claimant by employer. Defenses raised by the employer were insufficiency of the medical evidence and excessive cost of the lift. COCA sustained the trial court decision holding the following:

  • Rule 20 applies to all medical reports for use in evidence, including those that concern the need for medical equipment and apparatus.
  • "Where an … injury necessitates the modification or substitution of an automobile in order to accommodate a wheelchair or artificial member and to restore in part a claimant's former ambulatory ability, such costs may be awarded as ‘other apparatus.’" Fidelity and Casualty Co. v. Cooper, 382 So.2d 1331, 1332 (Fla.Dist.Ct.App. 1980)(citations omitted. This rule has been followed by other courts in holding that specially equipped vans are compensable medical treatment/apparatus under statutes similar to section 14 (A). See Terry Grantham Co. v. Indus. Com'n, 154 Ariz. 180, 741 P.2d 313 (Ct.App. 1987); see also Meyer v. North Dakota Workers' Compensation Bureau, 512 N.W.2d 680 (N.D. 1994).
  • [W]e must allow for the trial court to weigh the type of equipment set out in each of the cost estimates, in light of the medical evidence of Claimant's condition, in deciding which lift she needed. In review of a decision concerning the necessity of certain equipment, claimant's evidence must be liberally construed in her favor, because she is entitled to all reasonable inferences that can be drawn from the evidence. Crouch v. West Virginia Workers Comp. Comm., 184 W.Va. 730, 403 S.E.2d 747, 750-51 (1991) (holding a van specially equipped to accommodate a wheelchair was an "approved mechanical appliance").
  • [I]t is the employer's burden to have a claimant explain accessories whose necessity may be questionable. Edgewood Boys' Ranch Found. v. Robinson, 451 So.2d 532 (Fla.Dist.Ct.App. 1984) (upheld an order for a specially equipped van). An order to provide the special equipment set forth in a claimant's cost estimate will be upheld so long as the cost estimate is not excessive on its face.
  • Employer in the instant case offered both expert medical evidence and technical/cost estimate evidence to support its contention that Claimant may not need the lift at all, or at least did not need the lift reflected in her cost estimates. This evidence was indeed compelling and presented a sharp conflict for the trial court to resolve. However, the issue of the necessity of medical treatment or equipment is a question of fact for determination by the trial tribunal. [Emphasis added.]

Oklahoma Gas & Electric Co. v. Chronister, 2005 OK CIV APP 32, 114 P.3d 455 (rental of handicap-accessible van)

3. Attendant Care by Non-medical Assistants

The employer shall promptly provide for an injured employee such medical, surgical or other attendance . . . as may be necessary after the injury.
85 O.S. §14A1

85 O.S. §14A1 provides that the employer shall provide the injured worker with medical and "other attendance" after his injury. For severely debilitating injuries this includes necessary assistance (in some cases 24 hours) from family members who must be paid for their time. The language is not limited to licensed nursing staff. Oil Well Cementers, Inc. v. Thompson, 2004 OK CIV APP 4, 82 P.3d 125; Wilson Paving, Inc. v. Abernathy, 2003 OK CIV APP 72, 76 P.3d 103.

Oklahoma Gas & Electric Co. v. Chronister, 2005 OK CIV APP 32, 114 P.3d 455 (home care by claimant's wife) sets the criteria for home health care performed by a spouse:

[W]e conclude that criteria described in Warren Trucking Company, Inc. [v. Chandler], 221 Va. 1108, 277 S.E.2d 488, (1981), provide an appropriate framework for determining whether an injured worker may receive workers' compensation benefits for the home health care performed by a spouse. As those criteria apply under Oklahoma law, an employer must pay for home health care performed by the spouse of an injured worker when: (1) the employer knows of the need for home health care as a result of a work-related injury, (2) a physician recommends the home health care as medically necessary as a result of the work-related injury and describes with a reasonable degree of particularity the nature and frequency of the duties the spouse will perform, (3) the home health care the spouse will perform is of the type usually performed by trained attendants and is beyond the scope of normal household duties, and (4) there is evidence of the reasonable value of the services to be performed by the spouse.

4. Continuing Medical Maintenance (CMM)

The employer shall promptly provide for an injured employee such medical, surgical or other attendance or treatment, nurse and hospital service, medicine, crutches, and apparatus as may be necessary after the injury.
85 O.S. §14A1.

After an award for permanent disability, the right to receive further medical treatment ceases by operation of law except under very limited situations. A permanently disabled worker may only receive services which do not afford an alteration or improvement of his physical condition, but constitute merely day-to-day maintenance of the worker's permanently disabled condition. Bill Hodges Truck Co. v. Gillum, 1989 OK 86, 774 P.2d 1063.

The employer has a continuing duty under 85 O.S. §14 to furnish medical treatment for a compensable injury for as long as it is needed, and this duty is not limited to the period of temporary total disability. Orrick Stone Company v. Jeffries, 1971 OK 116, 488 P.2d 1243. An injured worker may be awarded CMM for as long as it may be needed if it is included in the permanent partial disability order. Pitchford v. Jim Powell Dozer, Inc., 2000 OK 12, 996 P.2d 935. If properly awarded, CMM is not subject to the Title 85 O.S., §43 limitation period for reopen on a change of condition, Leach v. Hamilton Trucking Co., 2002 OK CIV APP 11, 39 P.3d 824, 828, and continues until the Workers' Compensation Court finds it is no longer needed. Baxter v. Montgomery Exterminating, 1998 OK CIV APP 75, 962 P.2d 666.

A court order placing time limitations on CMM must be based on medical evidence. Since there is no statutory authority for the Workers' Compensation Court to limit CMM as a matter of law, a court's finding limiting CMM to a period of six months is erroneous and must be vacated in the absence of medical evidence. Baxter v. Montgomery Exterminating, 1998 OK CIV APP 75, 962 P.2d 666.

It is implicit in an order awarding hearing aids that the order "would remain in effect for as long as necessary to maintain Claimant at his hearing level at that time." Leach v. Hamilton Trucking Co., supra.

Claimant’s total knee replacement was covered by a 1994 CMM order which only provided for “periodic checkups under the supervision of Dr.Feild.” In 2006 claimant went to Dr. Feild for the first time since the award. Claimant was found to have a deteriorating TKR and needed repair or replacement of its parts. Respondent objected to a request for medical treatment asserting that claimant must seek COCW even though the statue of limitation had clearly expired. On appeal the trial court order authorizing repair of the knee was upheld, and the COCA found that “eventual replacement [of the implant] was a necessary implication of the CMM, although not expressed.” Champlain v. Schwans Sales Enterprises, COCA Div IV, Case No. 102,945 (unpublished).

5. Other Issues

5.1. Treatment Guidelines of PAC

The Physician Advisory Committee (PAC) is authorized to "adopt treatment guidelines and protocols for treatment of injuries, including, but not limited to, injuries to the hand, wrist, back, knee, neck and shoulder." After public hearing and adoption by the Court Administrator, compliance with treatment guidelines is mandatory and the employer or its insurer are not required to pay for treatment which is not in compliance with the guidelines. 85 O.S. §201.1.

Current Guidelines
Treatment Type Eff. Date
Chronic Pain 09/01/2007
Opioid Medications 11/01/2007
Upper Extremity 11/01/2007
Lower Extremity 09/01/2007
Cervical Spine 08/15/2009
Lumbar Spine 08/15/2008

5.2. Certified Workplace Medical Plan (CWMP)

Campbell v. Hunt JB Transport Services, 2002 OK CIV APP 33, 43 P.3d 421.

5.3. Reimbursement of Employee's Payments

Where an employer is under an express statutory duty to provide the injured employee with medical treatment including but not limited to medicine, Oklahoma case law has construed this statutory authority to impliedly permit employees' reimbursement for their related, reasonable and necessary medical expenses. See generally Depue, 493 P.2d at 82-82; Jobe v. American Legion, 2001 OK 75, 32 P.3d 860; Armstrong v. Unit Drilling, 2002 OK 17, 43 P.3d 383; Campbell v. Hunt JB Transport Services, 2002 OK CIV APP 33, ¶ 7, 43 P.3d 421, 423 (providing "[a] goal of the Workers' Compensation Act is to insure that medical expenses of an employee who has suffered an on-the-job injury will be paid.")
Blythe v. University of Oklahoma, 2003 OK 115, 82 P.3d 1021, fn5.

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