Matter of Kigin v. State Workers’ Comp. Bd.

In 2010, the Workers’ Compensation Board (“Board”) adopted Medical Treatment Guidelines, which include a list of pre-authorized medical procedures and set forth limitations on the scope and duration of each procedure. The Guidelines also set forth a variance procedure, under which the medical treatment provider requesting a variance must demonstrate that the requested treatment is medically necessary. In 2009, Claimant received authorization from the Special Fund for Reopened Cases (“the carrier”) for acupuncture for chronic neck and back pain that she suffered as a result of work-related injuries. In 2010, a doctor recommended that Claimant receive additional acupuncture treatment and requested two variances under the newly-created Guidelines. The carrier denied the variance requests. A Workers’ Compensation Law Judge determined that Claimant’s medical provider failed to show that the additional acupuncture treatments were medically necessary, and the Board affirmed. The Appellate Court affirmed. The Court of Appeals affirmed, holding (1) the Board did not exceed its statutory authority in promulgating the regulations; (2) the variance procedure does not improperly shift the burden to the claimant’s treating physician to prove medical necessity; and (3) the Guidelines do not deny injured workers due process. View "Matter of Kigin v. State Workers' Comp. Bd." on Justia Law