Employer Ordered to Pay for Medications

The worker suffered a low back injury at work.  The parties subsequently agreed to a settlement that allowed the claimant to continue to receive medically reasonable and necessary treatment that was related to the work injury.  The employer filed for discontinuance of medications based on a records review that concluded the medications were not necessary for treatment of a work-related injury but rather for other personal medical conditions.  The doctor also questioned whether the use of some of the medications, which were being used in “an off-label context,” was medically appropriate.  Perry v. State of Vermont, Op. No. 13-13WC (2013).

The Department of Labor concluded that the employer is responsible only for those medical treatments that are reasonable and causally related to the injury.  Perry v. State of Vermont, Op. No. 13-13WC (2013) (citing 21 V.S.A. §640(a); Baraw v. F.R. Lafayette, Inc., Op. No. 01-10WC (2010); MacAskill v. Kelley Servs., Op. No. 04-09WC (2009)).  Utilizing the commonly cited five factor test, the Department concluded that the claimant’s treating doctor’s opinions as to causality and necessity were more credible than the employer’s doctor’s opinions. Perry v. State of Vermont, Op. No. 13-13WC (2013) (citing Geiger v. Hawk Mountain Inn, Op. No. 37-03 (2003)).  Specifically, the Department cited the fact that the claimant’s expert was a treating physician and that relationship allowed him to: differentiate between the work-related injury symptoms and the symptoms that resulted from personal medical issues; and use trial and error to create a successful pharmacology regime evidence by better pain control, fewer drugs and lower dosages.  Perry v. State of Vermont, Op. No. 13-13WC (2013).  The Department further concluded that the employer’s expert opinion was based on an assumption, rejected by the Department, that the claimant’s personal medical diagnosis excluded all other possible causes for the worker’s pain complaints.  Such reliance rendered his opinion unpersuasive.  Perry v. State of Vermont, Op. No. 13-13WC (2013).