Cayo v. Precision Inc. and SFM Mutual Ins. Co.

Cayo v. Precision Inc. and SFM Mutual Ins. Co., No. WC13-5586 (January 3, 2014) 

In this case, the employee sustained a significant work-related low back injury in January 1997.  She underwent surgery, but was never pain free following the incident.  She sought treatment on a number of occasions over the years, and medical records from several providers indicate the employee had chronic low back and leg pain, nerve root damage, and degenerative disc disease.  Her treating doctor had prescribed oxycodone, but not on a regular basis.  As if the employee’s luck could not get worse, she was involved in a motor vehicle accident in 2004, which purportedly flared up her back symptoms requiring additional medical treatment and narcotic prescriptions, including oxycodone, to manage her pain.

At the hearing in 2013, the compensation judge found the prescription for oxycodone was reasonable, necessary, and causally related to the admitted work injury from 1997 and ordered the employer and insurer pay for the employee’s oxycodone prescription.

Unfortunately, in making this finding, the compensation judge relied on an inaccurate chart note, which stated the treating doctor had seen the employee before the motor vehicle accident in 2004.  The employer and insurer argued on appeal that relying on this chart note affected the ultimate conclusion that the need for the oxycodone prescription was causally related to the 1997 work injury.  But the WCCA affirmed, deciding the error in the chart note was not material to the treating doctor’s opinion and does not demonstrate any inadequate factual foundation for the treating doctor’s opinion on causation.

The WCCA clarified the issue in this case: it was not whether the 1997 work injury was the sole cause of the employee’s ongoing need for oxycodone, rather, the issue was whether the work injury was a substantial contributing factor to the ongoing use of the oxycodone for pain.  The WCCA found that it was not unreasonable for the compensation judge to conclude the 2004 motor vehicle accident (combined with the employee’s work-related low back condition stemming from the 1997 injury) aggravated or accelerated her condition, causing the employee’s need for oxycodone.