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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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  3. The practitioners and judges who hail E-filing as the Saviour of the West need to contain their respective excitements. E-filing is federal court requires the practitioner to cram his motion practice into pigeonholes created by IT people. Compound motions or those seeking alternative relief are effectively barred, unless the practitioner wants to receive a tart note from some functionary admonishing about the "problem". E-filing is just another method by which courts and judges transfer their burden to practitioners, who are the really the only powerless components of the system. Of COURSE it is easier for the court to require all of its imput to conform to certain formats, but this imposition does NOT improve the quality of the practice of law and does NOT improve the ability of the practitioner to advocate for his client or to fashion pleadings that exactly conform to his client's best interests. And we should be very wary of the disingenuous pablum about the costs. The courts will find a way to stick it to the practitioner. Lake County is a VERY good example of this rapaciousness. Any one who does not believe this is invited to review the various special fees that system imposes upon practitioners- as practitioners- and upon each case ON TOP of the court costs normal in every case manually filed. Jurisprudence according to Aldous Huxley.

  4. Any attorneys who practice in federal court should be able to say the same as I can ... efiling is great. I have been doing it in fed court since it started way back. Pacer has its drawbacks, but the ability to hit an e-docket and pull up anything and everything onscreen is a huge plus for a litigator, eps the sole practitioner, who lacks a filing clerk and the paralegal support of large firms. Were I an Indiana attorney I would welcome this great step forward.

  5. Can we get full disclosure on lobbyist's payments to legislatures such as Mr Buck? AS long as there are idiots that are disrespectful of neighbors and intent on shooting fireworks every night, some kind of regulations are needed.

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