The employee sustained an admitted low back injury in early 2001 when she tripped and fell against a filing cabinet striking her low back. The employee had a known history of degenerative disc disease after a series of injections and surgical intervention. The employee’s treating doctors started the employee on a plan of pain control that lasted almost ten years.
The employee settled the workers’ compensation claim for a lump sum payment with future reasonable and necessary medical treatment left open in February 2009.
In May of 2012, and at the request of the employer and insurer, the employee was seen by the IME doctor. The doctor opined that the employee had a pre-existing non-work related chronic multilevel disc degeneration and multilevel facet arthritis. The doctor stated any symptoms resulting from the employee’s work injury had long since resolved. Additionally, the doctor stated that the employee’s chronic narcotic medication use was not reasonable or necessary treatment for the employee’s symptoms as the medical records failed to demonstrate an improvement in function or pain control.
After the employer and insurer ceased payment for narcotic medication, the employee filed a Medical Request which was denied by the compensation judge. The judge found that the continued medication was not reasonable or necessary treatment and that they were unrelated to the employee’s work injury.
The employee appealed to the Workers’ Compensation Court of Appeals, stating that the compensation judge’s findings of facts were clearly erroneous and unsupported by substantial evidence. The appellant court affirmed the decision of the compensation judge stating that the compensation judge found the opinion of the pain management IME to be more persuasive than the opinions of the employee’s treating doctors.
The Court specifically points out that in this situation there was no indication in the employee’s medical records that her function or discomfort improved over the twelve years of narcotic use.