When do workers get to choose their own doctors following a workplace injury? That’s the issue in this case in which a car part fell on a worker’s head.
Heyward Sellers was struck in the head by a transmission frame while employed at a car repair shop. He suffered a compensable injury – no question about that.
Nine months after he suffered the injury, doctors said Sellers reached maximum medical improvement. He was awarded a 10% permanent partial disability to the cervical spine. The Connecticut Workers’ Compensation Commission approved an agreement between Sellers and his former employer 18 months after he was injured.
Years later, Sellers continued to get help with pain management from his treating physician.
However, he also saw two other doctors who weren’t approved by his insurance. Sellers sought reimbursement for treatment by his approved treating physician and the other two doctors.
A workers’ compensation commissioner found:
- The pain medications prescribed by his approved treating physician were palliative rather than curative, therefore they’re weren’t reasonable and necessary medical treatment after a certain date.
- The commissioner found only one doctor had been approved as Sellers’ treating physician, so the care from the other two doctors wouldn’t be covered.
The Workers’ Compensation Commission approved the commissioner’s findings. A Connecticut appeals court recently issued its ruling in the case.
Sellers argued that the commissioner incorrectly found that his treatment for pain was palliative rather than curative only because the medications didn’t permit him to return to work.
But the court agreed with the commissioner’s findings. The commissioner had approved additional testing for Sellers. His treating doctor could approve more treatment after the testing. If that were the case, it would be determined at that time whether it was reasonable and necessary.
Regarding the treatment by the two other doctors, the court referred to Connecticut state law which says:
“A claimant should obtain permission to change physicians before commencing a new course of treatment. This may include a valid referral from an authorized physician.”
Since Sellers didn’t produce evidence that anyone authorized a change in doctors, the court affirmed the commissioner’s decision that treatment from the two other doctors shouldn’t be covered.
Recently, we wrote about an Illinois case in which an injured worker chose to follow the advice of his own doctor rather than the treatment plan prescribed by the doctor approved by his employer and its workers’ comp insurance company. An Illinois appeals court approved comp benefits for the treatment prescribed by the worker’s doctor, writing, “As claimant was following the advice of his own qualified physician, we could not say that his choices were unreasonable.”
This goes to show how workers’ comp law and court decisions can vary from state to state.
What do you think about the Connecticut court’s ruling? Let us know in the comments.
(Heyward Sellers v. Sellers Garage Inc., Connecticut Appellate Court, No. AC 35848, 3/10/15)