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Court examines future medical care in workers' comp case

November 4, 2011

The Indiana Court of Appeals ruled Friday that just because a worker injured on the job reaches the maximum amount of compensation allowed by state statute, that doesn’t mean that future care won’t be needed, and that may warrant additional payments in order to continue treating pain or injury from the underlying accident.

In a unanimous decision in Randall Perkins v. Jayco, Inc., No. 93A02-1104-EX-361, a three-judge appellate panel found the Indiana Worker’s Compensation Board applied an incorrect inference in affirming a single hearing board member’s decision to deny an injured man’s request for palliative care.

In December 2003, Randall Perkins was working at Jayco when 1,000 pounds of laminated panels fell and injured him. The employer provided temporary total disability compensation and medical expenses for the injury, but a single hearing board member later denied Perkins’ additional claim for future medical expenses because he’d already been compensated and was at the maximum medical improvement (MMI) from his primary treating physician and other doctors. The full Worker’s Compensation Board found Perkins had reached MMI, but didn’t make any finding regarding his palliative care request.

After the Court of Appeals remanded the case in 2009 with instructions for the board to address that palliative care issue, a single hearing member in 2010 determined that Perkins is not in need of any additional medical care, including palliative care, because he’d already reached the maximum for compensation. The full board affirmed that second ruling, and Perkins appealed again.

The appellate panel found nothing wrong with how the single hearing member and board addressed the case procedurally and included new findings, but reversed on the issue of future care being impacted by the maximum medical improvement.

Judge Edward Najam wrote that MMI does not speak to the need for future care that could limit or reduce the patient’s impairment, such as when an employee with a permanent back disability has reached the limit with regard to healing but pain continues.

“Treatment of that pain may mitigate, though not alleviate, the effects of the disability,” he wrote. “Such is the nature of palliative care allowed under (Indiana Code) Section 22-3-3-4(c). Here, again, the Board concluded that a finding of MMI allows an inference that future treatment is unnecessary. But MMI relates to a curative state. Palliative care does not. Instead, palliative care is treatment to reduce the effects of an impairment, not to cure the condition causing the impairment.”

Even with that finding, though, the appellate panel determined the error was harmless because the board found Perkins’ future treatment request was unrelated to his December 2003 work accident and was a pre-existing condition. In the end, the judgment denying Perkins’ request for future medical treatment wasn’t wrong, the appellate court wrote.
 

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