The Delaware Industrial Accident Board has been a issuing decisions of interest in rapid-fire succession in the New Year and I am remiss to not have caught up on all the great stuff out there to report. Give me time to get you all up to speed, but in the mean time I am here to share with you a little potboiler of a decision that left me turning the pages breathlessly as though I were reading one of those dirty little Harlequin romance novels. Are those still in print ? . . . actually I checked online and they are. And their motto-- "Where a happily ever after is always guaranteed." Well, perhaps not if your name is Kathleen Mason or Deborah Ruffner.
Enter the ruling of the week in Kathleen Mason v. State of DE, IAB Hrg. # 1198102 (1/15/10) which was brought to my attention by colleague Dennis Menton, who handled the State's representation and was apparently still enjoying the spoils of victory. And frankly, this opinion was already on the top of my "to do" list, second only to last week's case about the Section 2322F fine.
Here are the facts in terms of what is important: The case had not been sent out for Utilization Review because the massage therapist (Ms. Ruffner) was not a certified provider. Claimant filed a DACD for medical bills and for travel expense and massage therapy was one of the items. The State took the position that the massage therapy bills from Back in Action were not compensable because the provider was not certified and did not obtain pre-authorization for treatment.
The law of the case according to this author:
On a collateral note, the Board did award the claimant mileage for three roundtrips per week to the YMCA closest to her home for aqua therapy.
Well, as we all prepare for the coming snowstorm and a potentially housebound weekend, I for one will be scanning the IAB rulings for next week's posts. I really enjoyed this case. The thought that keeps coming to mind is that if you want to play on the home team, you need a copy of the rule book. We now have these Practice Guidelines and certification requirements and if you are a provider who cannot keep up, you ought to be benched. Good going, IAB!
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