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A former construction worker who fell 14 feet at a work site 29 years ago and suffered a back injury is not eligible for additional treatment and medications, including opioids for pain and the erectile dysfunction medicine Viagra, West Virginia’s highest court ruled Thursday.
The man’s case volleyed between the Office of Judges and the Board of Review since he was denied an additional MRI in 2018, a move the Office of Judges reversed that same year because “updated diagnostic testing could be beneficial in determining the cause of (his) persistent pain.” The Board of Review reversed in 2019, stating that in reviewing two previous MRIs from 2008 and 2012, the man’s condition was a “progression of noncompensable, age-related degenerative joint and disc disease of the spine,” according to documents in No. 19-0255, filed in the Supreme Court of Appeals of West Virginia in Charleston.
Also attached to the appeal was a claims adjustor’s subsequent denial of several medications that included and opioids and erectile dysfunction medication, which the Office of Judges reversed, ordering that the medications be continued. The Board of Review later affirmed most of the medications, which included medication for acid reflux, but reversed the order for opioids and Viagra, pointing to doctor testimony that found the man had “many risk factors for sexual dysfunction, none of which are the result of the compensable injury.” On pain medication, the board found that the prescriptions would require certain documentation under state law “when such medications are prescribed outside of the limited time periods after an injury or surgery,” documents state.
Five judges on Thursday unanimously affirmed the board’s decision, writing that the worker “has had two MRIs, both of which showed a progression of degenerative changes” and that an additional doctor “performed an independent medical evaluation and determined that another MRI was unnecessary as related to the compensable injury.”
“We also find that there is no indication that the requirements of (state law) have been met in regard to (opioids). Further, a preponderance of the evidence indicates that Viagra is not medically necessary or reasonable to treat a compensable injury in the claim,” the ruling states.
An appeals court in California on Friday upheld the insurance fraud conviction of a police officer who filed two similar workers compensation claims in five years, finding a lack of proof of the second injury and that he had been found to have made false statements.