Court Addresses Standard for Replacing Medical Equipment

Claimant, John Berry, was injured in 1986 while working for the Department of Transportation and Development (DOTD) and soon after began receiving workers’ compensation benefits.  DOTD supplied Claimant with a Tempur-Pedic bed and mobility scooter.  The scooter was repaired and replaced by DOTD a number of times prior to the enactment of the Medical Treatment Guidelines (“MTG”).  In 2014, the DOTD unsuccessfully challenged Claimant’s entitlement to benefits and, on appeal to the Louisiana Second Circuit Court of Appeal, the WCJ’s decision finding that Claimant was permanently and totally disabled was affirmed.

Claimant’s pain management physician, Dr. Forte, submitted a Form 1010 and medical records supporting a request for a replacement bed and scooter.  DOTD denied the request and the OWC medical director agreed, noting that sufficient documentation was not submitted to satisfy the MTG.  Following a trial on the issue, the WCJ ordered the DOTD to replace Claimant’s bed and scooter on the basis that Claimant was permanently and totally disabled and this equipment was instrumental in maintaining his everyday life.

The DOTD appealed, in pertinent part, on the basis that the WCJ erred in finding that Claimant had proved by clear and convincing evidence that the decision of the medical director was not in accordance with the MTG.  The DOTD argued that Claimant did not satisfy the minimum requirements for an “initial request for authorization.”  The Second Circuit dismissed this argument, noting that Claimant was seeking to replace existing equipment, not request authorization for new equipment.  Additionally, the DOTD asserted that the request fell under the chronic pain disorder section of the MTG, requiring a physician to determine that the requested equipment is effective and necessary for treatment of chronic pain, which Claimant’s request supposedly failed to do.  The Court noted that the OWCA chronic pain guidelines suggest that, when available, it is preferable for more specific treatment guidelines to be applied.  In this instance, the Second Circuit found that sections of the MTG related to durable medical equipment should be applied.  Since the DOTD and medical director had previously determined that the bed and scooter were necessary medical treatment at some point, the Second Circuit affirmed the WCJ’s decision ordering the DOTD to replace Claimant’s Tempur-Pedic bed and scooter.

Berry v. Dep’t of Transp. & Dev.