Compensable Consequence Not Proven From Original Injury

The applicant had an industrial injury on March 13, 1996. The admitted injury is to the right shoulder.

The applicant had arthroscopic surgery in March 1997. The applicant returned to work in November 1997.

The applicant noticed a gradual increase in pain to his wrists, hands, right shoulder, and right forearm on return to work. The applicant worked until he resigned in March of 2001, because of the pain.

The applicant attended a Qualified Medical Examination (QME) and was declared permanent and stationary.

The QME indicated that the applicant started experiencing carpal tunnel syndrome immediately postoperative right shoulder surgery.

The applicant amended his original claim to include left shoulder, elbows, hands and wrists. The issue of whether these body parties were a compensable consequence were presented to a Workers’ Compensation Judge (WCJ). The WCJ indicated that the QME had an inadequate analysis and summary. The WCJ ruled the only injury was to the right shoulder. The Workers’ Compensation Appeals Board (WCAB) denied the petition for reconsideration filed by the applicant and agreed with the WCJ.

The wording in the appellate decision is important for this kind of allegation. The court stated that the QME did not conclusively opine that the wrist injury was either a direct result of the original injury or surgical procedure to connect to the original injury. Nothing in the QME’s report suggests a link between the carpal tunnel and the shoulder injury. They indicated you need conclusive medical opinion derived from medical analysis to support this type of opinion.

This is a noteworthy case.

ACOEM Treatment Guidelines Discussed Under Labor Code Section 4604.5 (c)

The applicant had an industrial injury on July 27, 1999. This was an admitted injury to his back. The applicant was referred by his primary treating physician to a physician who specialized in pain management.

The pain management doctor started the applicant on many different medications. The doctor indicated that the applicant had a low testosterone level and the applicant was paying for the testosterone treatment himself, but could no longer afford it due to his reduced earning capacity from the industrial injury. The doctor prescribed testosterone cream therapy to counteract the applicant’s decreased testosterone level due to the use of opiate medications prescribed for the industrial injury.

A dispute arose. The defendant sent the request for utilization review. The utilization review doctor denied the request for the treatment. The issue was presented to the Workers’ Compensation Appeals Board (WCAB). The Workers’ Compensation Judge (WCJ) awarded the applicant the treatment stating it was necessary to cure and/or relieve from the effects of the industrial injury.

On opinion and decision after reconsideration the WCAB analyzed Labor Code section 4600 and 4604.5 ©). 4600 states “cure or relieve.” They indicated that “cure or relieve” and “cure and relieve” have been used interchangeable for decades.

They cited a California Supreme Court case for support. They further indicated 4604.5 uses both terms. The WCJ language of “cure and/or relieve” was consistent with prior court interpretations. They indicated that medical treatment which is intended only to relieve, but not cure, the effects of an industrial injury is acceptable under Labor Code section 4600. The phrase “cure or relieve” is identical to “cure and relieve”.

The testosterone treatment was allowed.

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