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COA reverses worker's comp board on prescription drug denial

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The Indiana Court of Appeals reversed a finding by the state Worker’s Compensation Board that a woman’s employer isn’t responsible for providing a specific prescription drug to her, noting that the board only focused on one possible reason why the drug is prescribed.

In Yvette Albright v. Four Winds International, No. 93A02-1010-EX-1324, Four Winds International employee Yvette Albright appealed the decision by the full Indiana Worker’s Compensation Board that affirmed her employer doesn’t have to provide prescription Cymbalta to Albright. Albright developed neck pain and numbness as a result of her work wiring recreational vehicles and was given an 18 percent permanent partial impairment of the body. Four Seasons agreed to compensate her for the injury.

Albright’s doctor prescribed Cymbalta to help control Albrights’ paresthesias, which causes skin sensations and is usually associated with injury or irritation of a nerve. Her doctor later increased the dosage and found the increase helped Albright deal with the pain caused by the condition. She later filed an application for adjustment of claim and her medical records were reviewed by Dr. David Poder. He found the prescription drug to be an appropriate treatment for her condition.

The single hearing member denied Albright’s claim, finding her doctor didn’t submit a detailed report about how much pain relief Albright had with the drug, and that Albright isn’t entitled to payment for indefinite ongoing medication for depression and anxiety.

The Court of Appeals found the full board erred in denying Albright’s claim for Cymbalta. The board made no finding that the drug isn’t properly prescribed for pain generally or to treat Albright’s neuropathic pain, wrote Judge Edward Najam. There isn’t even evidence in the record from which the board could conclude that Cymbalta is only used to treat depression.

The judges also found that Albright’s attorney and personal doctor did submit detailed reports on Albright’s condition and how much pain relief Albright had while taking Cymbalta.

“There is evidence in the record to support findings that Cymbalta was helping Albright’s psychological issues as well as her paresthesias. In light of the broadly stated issue presented to the Board in the Stipulation, the Board should have separately considered each reason for the treatment in determining whether Four Winds is responsible to provide that medication,” wrote Judge Najam.

He wrote there is also evidence that her paresthesias is related to her neck injury. Based on all the evidence, the board should have entered an award in favor of Albright. The judges remanded to the board to determine how long Four Winds should be required to provide the drug and request and consider additional evidence on that issue if necessary.

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  1. KUDOS to the Indiana Supreme Court for realizing that some bureacracies need to go to the stake. Recall what RWR said: "No government ever voluntarily reduces itself in size. Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we'll ever see on this earth!" NOW ... what next to this rare and inspiring chopping block? Well, the Commission on Gender and Race (but not religion!?!) is way overdue. And some other Board's could be cut with a positive for State and the reputation of the Indiana judiciary.

  2. During a visit where an informant with police wears audio and video, does the video necessary have to show hand to hand transaction of money and narcotics?

  3. I will agree with that as soon as law schools stop lying to prospective students about salaries and employment opportunities in the legal profession. There is no defense to the fraudulent numbers first year salaries they post to mislead people into going to law school.

  4. The sad thing is that no fish were thrown overboard The "greenhorn" who had never fished before those 5 days was interrogated for over 4 hours by 5 officers until his statement was illicited, "I don't want to go to prison....." The truth is that these fish were measured frozen off shore and thawed on shore. The FWC (state) officer did not know fish shrink, so the only reason that these fish could be bigger was a swap. There is no difference between a 19 1/2 fish or 19 3/4 fish, short fish is short fish, the ticket was written. In addition the FWC officer testified at trial, he does not measure fish in accordance with federal law. There was a document prepared by the FWC expert that said yes, fish shrink and if these had been measured correctly they averaged over 20 inches (offshore frozen). This was a smoke and mirror prosecution.

  5. I love this, Dave! Many congrats to you! We've come a long way from studying for the bar together! :)

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