Hillstad v. Havenwood Care Ctr., No. WC 13-5617 (January 22, 2014)
In Hillstad, the WCCA reversed a partial reduction of prescription expenses when the Compensation Judge failed to provide a clear rationale for the reduction.
The employee sustained a low back injury while working for Havenwood Care Center. The employee was recommended by her treating physician to undergo a microdiscectomy and later a fusion surgery which were both denied by the employer and insurer. The employee also claimed prescription medication expenses totaling $19,123.51,which she had accrued over the course of one year and nine months. The prescriptions were filled by intervenor Injured Worker’s Pharmacy (IWP). The employer and insurer denied payment for the prescription medication expense on the basis of two IMEs, which opined that they were not indicatednor reasonable and necessary. The employee’s treating physician felt that the prescription medication was used to treat the employee’s work injury.
The Compensation Judge approved the recommended surgery but determined that a 20% portion of the medication expense was excessive, unreasonable and unnecessary.
IWP appealed the Judge’sdenial of 20% of the intervention claim contending that the Compensation Judge had rejected both IMEs and, therefore, no facts supported the reduction of the Award. The WCCA rejected IWP’s argument, noting that there was no indication that the Compensation Judge rejected the IME opinions in their entirety. Nevertheless, the WCCA was unable to identity a rationale for the 20% reduction of the intervention claim and remanded that issue for reconsideration and explanation.