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A workers’ compensation judge was wrong to deny a claimant continued benefits for his physical therapy just because the treatment was only palliative in nature, the Pennsylvania Commonwealth Court has ruled. Led by President Judge Joseph T. Doyle, the three-judge panel in Trafalgar House v. WCAB said a doctor’s treatment does not have to work toward curing a patient to be considered reasonable and necessary. Treatment that simply manages symptoms or pain also is eligible for compensation, the court said. Jonathan Green, the claimant, injured his lower back on Nov. 18, 1993, while working for Trafalgar House & St. Paul Fire & Marine Insurance, which the opinion referred to as the employer collectively. He began receiving benefits in January 1994 pursuant to a notice of compensation payable. As part of his medical treatment, Green received pain and anti-inflammatory medications, physical therapy, aqua therapy, moist heat, electrical stimulation, ultrasound and osteopathic manipulation, Doyle said. The employer filed a utilization review petition requesting a review of the reasonableness and necessity of the treatment rendered to Green by his provider, Edward E. James, D.O. The utilization review organization initially found that the treatment was reasonable and necessary only for three months, but James asked for reconsideration. On reconsideration, the URO said the treatment was reasonable and necessary for six months. James was still not satisfied with the URO’s determination and filed a review petition. A workers’ compensation judge denied the petition, finding that Green did not prove that ongoing physical therapy was needed to treat his work injury. Green appealed to the Workers’ Compensation Appeal Board, which found the WCJ improperly placed the burden of proof on Green and remanded. On remand, the WCJ again concluded Green’s ongoing treatment was not reasonable or necessary. The WCAB reversed the WCJ on appeal, stating that the lower tribunal erred by basing its decision on the belief that Green’s treatments were only palliative. Citing the Commonwealth Court case Glick v. WCAB, 750 A.2d 919 (Pa. Commw. 2000), the WCAB said a WCJ may not find that medical treatment is unreasonable or unnecessary solely on the basis of a determination that it is only palliative. In the opinion on the employer’s appeal to the Commonwealth Court, Doyle said that there is no “bright-line standard” to use when analyzing whether treatment is reasonable or necessary but that there are guidelines by which the court abides. In Cruz v. WCAB, from 1999, the court said treatment may be reasonable and necessary even if its only purpose is to manage a patient’s symptoms rather than cure the patient. The court said the same was true of treatment that only managed a patient’s pain in another 1999 case, Central Highway Oil CO. v. WCAB (Mahmod). “The standard, or guideline, enunciated in the above cases is that medical treatment may be reasonable and necessary even if the treatment does not cure the underlying injury, so long as it acts to relieve the pain and treats the symptomatology, i.e., if it is palliative in nature,” Doyle said. Therefore, Doyle said, the WCAB was correct in reversing the WCJ. None of the witnesses disputed the fact that James’ treatment was not expected to cure Green’s soft-tissue injuries, Doyle said, so the question was whether Green was still feeling pain and whether James’ treatment was relieving that pain. Green testified before the WCJ that he had relief from pain for a few days after treating with James. That was enough evidence to allow Green to continue to receive benefits, Doyle said. Daniel W. Deitrick of Marshall Dennehey Warner Coleman & Goggin in Pittsburgh represented the employer. Pittsburgh attorneys Amiel B. Caramanna Jr. and Alexander J. Pentecost represented Green.

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