In my previous post, I began an overview of the types of benefits which are available to a claimant under Virginia’s Workers’ Compensation Act. I identified two sources of benefits (“pots of money”) from which the most commonly awarded benefits are drawn: medical expenses and indemnity payments to cover wage loss. My post focused on medical benefits first, but as usual, I bit off more than I could chew easily in 1 post. Therefore, I have split the discussion of medical benefits into 2 more easily digested parts. In this second part, I look at medical expenses incurred for treatments and procedures which are not intended to be directly curative of the claimant’s symptoms, diagnostic testing and palliative care (pain management), and under what circumstances these procedures would be covered by the claimant’s employer.
The employer’s responsibility to pay for medical treatment includes an obligation to pay for diagnostic procedures in appropriate circumstances, even when there is no curative benefit directly to be gained from the tests. The employer is responsible for the cost of diagnostic procedures undertaken to determine (1) whether claimant’s condition is causally related to the compensable injury; (2) the extent of the injury resulting from the work accident; and (3) whether claimant requires additional medical treatment for the injury. Responsibility for diagnostic procedures is contingent upon a showing that the procedure is reasonable and necessary, is approved by the authorized treating physician (ATP), and the medicals indicate a possible causal connection between claimant’s condition and the compensable injury.
70 O.I.C. (1991).
The purpose of the Act’s provision for free medical care to injured workers is twofold: to put the burden of paying medical expenses on employers, and to restore employees to good health so that they can return to useful employment as soon as possible.
37 Va. App. 645, 561 S.E.2d 6 (2002). Claimants are sometimes reluctant to pursue palliative care because they have been told throughout their workers’ comp experience that comp does not pay for pain and suffering damages. Notwithstanding the general rule which does not award damages for pain in workers’ compensation cases, appropriate treatment with a pain management specialist will be included in claimant’s medical expenses especially where the ATP makes the referral to the physician furnishing the palliative care.
While there are numerous other issues which arise from payment of an injured employee’s medical expenses, they will have to wait until a later date for me to resume this discussion. Next up for me, I will commence a discussion of indemnity benefits to compensate for lost income from employment. Because indemnity is a more technical topic than medical expenses, it may take me some time and multiple posts to arrange my thoughts on that subject. I will begin that voyage shortly. As always, you are welcome to come along with me.