Fowler Bell Blog – Worker's Comp
A win for employers: Kingery v. Sumitomo Electric Wiring.
30 Oct 15
The Supreme Court handed down its decision on October 29, 2015. This case was reopened by the employer for a medical dispute to challenge prescription medications, two of which were narcotics. The ALJ found the treatment compensable. The Court of Appeals and Supreme Court reversed the ALJ.
The employer filed the opinion of a Dr. Randolph that medications were not reasonable and necessary for the work injury. Kingery filed no medical evidence to rebut the same. The ALJ disregarded Dr. Randolph’s medical opinion and relied solely on Kingery’s lay testimony.
The Court was very clear in its decision that it was not rendering a ruling on who had the burden of proof on causation. They didn’t need to because the evidence “compelled” a finding in the employer’s favor. Here there was no conflicting medical evidence. Thus there was no substantial evidence that Xanax and Celexa were for the work related condition. In fact the original opinion by the ALJ made clear that her mental health complaints were not related to the work injury. “She never reopened the original award to seek additional impairment for a worsening of her condition, and thus she is bound by the original award’s findings.”
As for Lorcet and Skelaxin the issue of causation, as well as reasonableness and necessity, is a question properly within the province of medical expert opinion. Kingery’s has a host of subjective complaints, and a laundry list of personal health problems.
“Such questions are solely within the province of medical experts who are equipped with the proper education and experience to enable them to provide reliable answers within a reasonable degree of medical probability. We cannot accept ignoring uncontroverted medical evidence in favor of unreliable lay testimony and the ALJs’ own proclivities and experience when determining such medical issues. That is not substantial evidence.”
In their dissent Justices Minton, Barber and Kelly opine that the Court elected to re-weigh the evidence, thus usurping the role of the ALJ.
Comment: This is the correct decision. I will certainly grant that it can be difficult for claimant’s to secure the opinion of their medical doctors. However, if the doctor sees fit to prescribe drugs, and bill someone for it, they should certainly be willing to briefly explain why—at no additional charge.