District of Columbia: Remand Required Where Review Board Fails to Determine Medical Issues on their Merits

The District of Columbia Court of Appeals reversed a significant portion of an order by the Compensation Review Board (CRB) that found an injured worker was not entitled to compensation for proposed medical treatments on the basis that they were not reasonable and necessary. The worker, a former bus operator for WMATA for 20 years, sustained neck and lower back injuries in 2006 and never returned to work. In 2008, the parties agreed that WMATA would be liable for all reasonable and necessary medical expenses that were causally related to the accident. The worker’s physician treated her with intramuscular injections, muscle relaxants, pain medication, anti-inflammatory medication, sleep medication, and physical therapy. In 2012, WMATA denied approval for additional treatment. An IME was performed. It indicated the worker needed no additional treatment. A utilization review was conducted and it found further treatment by the physician was not reasonable and medically necessary. When the worker contested the determination, an ALJ denied her claim, finding that the IM injections were not reasonable and necessary. The ALJ made no findings, however, that the other treatments—muscle relaxants, pain medication, anti-inflammatory medication, sleep medication, and physical therapy— were reasonable and necessary. The CRB affirmed. The appellate court indicated that with its limited role on appeal, there did appear to be substantial evidence to support a finding that the proposed IM injections were not reasonable and necessary. The other treatment issues had never been determined on the merits and remand was, therefore, necessary.

Thomas A. Robinson, J.D., the Feature National Columnist for the LexisNexis Workers’ Compensation eNewsletter, is the co-author of Larson’s Workers’ Compensation Law (LexisNexis).

LexisNexis Online Subscribers: Citations below link to Lexis Advance. Bracketed citations link to lexis.com.

See White v. District of Columbia Dep’t of Emp. Servs., 2015 D.C. App. LEXIS 281 (July 23, 2015) [2015 D.C. App. LEXIS 281 (July 23, 2015)]

See generally Larson’s Workers’ Compensation Law, § 130.04 [130.04]

Source: Larson’s Workers’ Compensation Law, the nation’s leading authority on workers’ compensation law.

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