The Employee, Wayne Armstrong, suffered a work-related injury on September 19, 2007 to his neck, right arm, and left leg. He began receiving physical therapy that only provided temporary relief. His employment ended with Clyde in 2010. He has not worked since and has been receiving Social Security benefits.
In the summer of 2009, the parties entered into a Stipulation for Settlement, resolving the Employee’s claims arising out of his September 19, 2007 work injury on a full, final, and complete basis, with the exception of claims for future medical treatment. According to the Stipulation, claims for future medical treatment “are limited by foreclosure of claims for … formal in or out patient pain programs, as defined by the treatment parameters, including MAPS…”
Throughout 2009 and 2010, the Employee regularly treated with Dr. Thomas Haus of Glacial Ridge, Glenwood Medical Center. An MRI of his neck and shoulder showed disc herniations at C6-C7 and Dr. Haus referred the Employee to the Center for Pain Management, where he was evaluated and injections were eventually performed.
The Employee began treating with Dr. George Kryder of Douglas County Hospital, Alexandria Clinic in 2014. Dr. Kryder recommended reducing the Employee’s use of narcotics and addressing obesity as a source of ongoing back pain, and referred the Employee to a physiatrist. In December 2014, the Employee underwent steroid injections at the Center for Pain Management. In late 2015, the Employee sought Dr. Kryder’s assistance to obtain approval for additional injections, however, the request for approval for a referral to the pain clinic was denied. The Employee continued to treat with Dr. Kryder into 2016. Despite denials from the insurer, Dr. Kryder continued to note that the Employee would benefit for a referral from physical therapy, a non-narcotic pain regimen, and pain management.
The employee underwent numerous IME’s by Dr. Robert Barnett and Dr. Donald Starzinski who both opined that the referral to a pain clinic was reasonable, but unrelated.
A Medical Request seeking approval for a physical therapy referral was filed. The treatment was denied following an administrative conference, and a request for a formal hearing was filed. Another medical request seeking approval for a MRI of the right shoulder and approval for a pain clinic consultation was also filed. The pleadings were consolidated and heard at a hearing on December 1, 2016. The Judge denied the claims for physical therapy and the MRI, which the Employee did not appeal. The Judge did find that the pain clinic consultation at the Center for Pain Management was reasonable, necessary, and causally related. The Judge rejected the argument that the treatment was closed out by the language in the Stipulation for Settlement.
On appeal, the WCCA affirmed noting that the referral did not specify what the treatment would be, the consultation could not be said to meet the requirements for a pain program under the treatment parameters, and was therefore not closed out by the agreement. Additionally, the Stipulation for Settlement did not foreclose a referral to a specialized pain center for all aspects of assessment, diagnosis, treatment recommendation, pharmacotherapy management, and pain management treatment. Although Dr. Kryder’s referral was for a “pain clinic,” the WCCA did not think that the approval to a pain clinic was equivalent to an authorization of a pain program as defined by the treatment parameters. It was noted that the Center for Pain Management provides services other than those that were foreclosed in the Stipulation.