A West Virginia teacher who fell off a chair on the playground was entitled to have her employer pay for surgery, the state Supreme Court of Appeals has ruled.

In March 2002, Marilyn G. Cook, who worked as a teacher for the Logan County Board of Education in West Virginia, slipped off a chair on the playground and landed on the pavement, injuring her elbow, head and back, according to court records.

An MRI showed degenerative changes to Ms. Cook’s lumbar spine, but neurosurgeon Dr. Panos Ignatiadis determined she was not a good candidate for back surgery.

Several years later, according to court records, a second MRI revealed multi-level degenerative changes. Records show that Dr. Ignatiadis decided Ms. Cook’s pain and symptoms were consistent with her 2002 injury and suggested she undergo spine surgery to repair the damage, as injections and medication didn’t alleviate her pain.

The claims administrator, however, denied authorization for the surgery and a post-surgery follow-up appointment. The West Virginia Workers’ Compensation Office of Judges affirmed its decision in May 2012, followed by the state’s Workers’ Compensation Board of Review in October 2012, according to records. Ms. Cook appealed, but the Office of Judges found that the surgery was not medically related or required to treat her compensable injury, despite there being no medical opinions in the record to disprove Dr. Ignatiadis’ explanation.

The decision of the Board of Review was reversed and remanded on April 19 by the West Virginia Supreme Court of Appeals on a 4-1 vote, with instructions to authorize Ms. Cook’s back surgery and a follow-up appointment.

“In determining that the requested surgery was not required to treat Ms. Cook’s compensable injury, the Office of Judges substituted its own judgment for that of Dr. Ignatiadis,” records state. “Dr. Ignatiadis provided the only medical opinion in the case, and it is clear from his deposition testimony that he believed the microdiscectomy (surgery) was a reasonable option for treating Ms. Cook’s pain.”