An employer must pay workers’ compensation benefits for a spinal cord stimulator for a worker who injured his back on the job more than 10 years earlier.
The Court of Appeals of Iowa upheld a lower court decision that found the worker’s continuing back pain was caused by his work injury despite one doctor’s claim to the contrary.
Badly injured when train struck wheel loader
In West Central Cooperative and Farmland Mutual Insurance Company v. Brett Sullivan, the employer, West Central Cooperative, had been paying workers’ compensation benefits to a worker who was injured in October 2011.
The worker suffered a severe back injury when the wheel loader he was driving was struck by a train. He required a lengthy hospital stay and a number of surgeries. West Central admitted the injury and paid for lost time and permanent partial disability benefits.
Eventually, the worker returned to his job until 2013 when both parties entered into a mutual separation agreement. At this point, the worker still required and was provided medical treatment for his injuries from the 2011 incident.
Back pain continued to worsen
As time went on, the back pain continued and the worker was eventually referred to Dr. Christian Ledet for pain management. Dr. Ledet evaluated the worker on June 22, 2018, and ordered various tests. In December 2018, after medication failed to alleviate the worker’s back pain, Dr. Ledet suggested the spinal cord stimulator.
More testing was needed before the spinal cord stimulator procedure could be completed. These tests were conducted in February 2019. The employer authorized and paid for all of the treatment recommendations up until this point.
Independent exam finds pain was psychological
West Central sent the worker to Dr. Joseph Chen for an independent medical exam. Dr. Chen felt that the worker’s injuries had healed and that his continuing back pain was tied to psychological issues rather than to the 2011 injury. He stated that the spinal cord stimulator procedure was unnecessary and that the continuing pain should be treated with a general flexibility exercise program and a consistent walking program.
Based on Dr. Chen’s report, West Central denied authorization for the procedure. The worker filed a claim for alternate medical care, which was denied by a deputy workers’ compensation commissioner who said the procedure wasn’t “reasonable and necessary treatment” since Dr. Chen had outlined a more reasonable course of treatment.
Denial overturned by commission, trial court
The worker appealed with the Iowa Workers’ Compensation Commission resulting in the denial being overturned because the medical evidence from Dr. Ledet pointed to treatment of the 2011 work injury.
Because of Dr. Ledet’s “specific expertise when it comes to treatment of chronic pain and implementation of neuromodulation devices” the commission found his opinion on appropriate treatment to be more persuasive than Dr. Chen’s.
A trial court that reviewed the case upheld the commission’s decision.
Appeals court: Decision based on ‘substantial medical evidence’
On appeal with the Court of Appeals of Iowa, West Central argued there wasn’t sufficient medical evidence connecting the worker’s continuing back pain to the 2011 injury.
However, the appeals court found the commission’s decision was based on substantial medical evidence so it upheld the prior findings. The appeals court also found the commission’s decision regarding the procedure being reasonable and necessary was also based on substantial medical evidence.