Court Denies Benefits for Specific Surgery, Finding Procedure was Considered “Alternative Medicine”

Georgia workers’ compensation claimants can encounter problems when requesting certain treatments. In a recent case before one state’s supreme court, the court had to consider whether a worker’s back surgery she had performed in Germany was compensable.

The worker suffered a back injury while working as a driller for a coal company. She underwent surgery and other treatments here in the U.S., but continued to experience pain. One doctor recommended a laminectomy, and the worker went to obtain a second opinion. The second doctor recommended a foraminotomy and transforaminal lumbar interbody fusions. The worker continued to investigate her options online and found an orthopedic surgeon in Germany. The German surgeon recommended two fusions and an implantation of an artificial disc. However, while the artificial disc was approved for use in Europe and several other countries, it was not approved in the U.S. by the Food and Drug Administration.

The worker flew to Germany and had the surgery performed, which appeared to be a success. The worker went back to work and was able to perform her previous duties. She even stopped taking pain medication. Yet, the state’s Workers’ Compensation Division denied compensation for the surgery. The Division found it was “alternative medicine” and was not reasonable and necessary medical treatment.

On appeal, the state’s supreme court determined that the Medical Commission’s reasonably concluded that the surgery was “alternative medicine” and that the worker did not provide sufficient evidence to support its safety and effectiveness. A case manager for the German doctor testified that she had seen “a lot of excellent results” but did not have a percentage of people who had achieved a positive outcome. The court explained that there was little evidence to support the safety and effectiveness of the procedure, and the testimony was too vague and too subjective. Therefore, the worker’s claim for benefits was denied.

Authorization of Medical Treatment under Georgia’s Workers Compensation Act

Under Georgia’s Workers’ Compensation Act, an employee has a right to medical treatment for the employee’s injuries. The employee is entitled to medical treatment, items, and services that are “reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment.” Medical treatment is normally paid for by the employer and the employer’s insurer. However, medical treatment must be provided through an authorized treating physician. Some tests and procedures require pre-authorization, and others may be denied after the services have already rendered.

Contact a Georgia Workers’ Compensation Attorney

If you were hurt on the job and have undergone or are considering an alternative medical treatment, consult an experienced workers’ compensation attorney. At the law office of J. Franklin Burns, P.C., we help our clients obtain all the benefits they are entitled to receive under Georgia’s Workers’ Compensation Act. Our Atlanta workers’ compensation lawyers have combined 50 years of trial experience and are passionate about fighting for the rights of injured workers and standing up to insurance companies. To learn more, contact our law firm for a free consultation and case evaluation by calling 404-303-7770 today.

More Blog Entries:

Court Denies Workers’ Compensation Benefits Due to Failure to Raise Issue During Initial Hearing, August 6, 2018, Atlanta Workers’ Compensation Lawyer Blog

Death Benefits under Georgia’s Workers’ Compensation Act, August 31, 2018, Atlanta Workers’ Compensation Lawyer Blog