Work Comp Attorneys Resolve Dispute Over Out-Patient Spinal “Surgery”
One of the priorities of the Texas workers compensation system is to help injured workers get back to their jobs. To do this often requires the help of work comp attorneys: this was very true in the following case, when expensive spinal treatment was required. But because many surgeries are so expensive, employers and insurers often fight being liable for vitally important surgeries. But in the following case, the injured worker wanted a less invasive surgery. But the procedure (IDET) might also mean a longer period of light duty and more surgeries. These facts are often why any injured worker is wise to immediately talk with qualified work comp attorneys. A lawyer will not only help identify and safeguard a worker’s comp rights, but may be essential in fighting for the right to comp coverage for new and highly effective medical treatments.
The hearings officer in this case declined to even hear the case: he said he “lacked jurisdiction.” The basis of this somewhat surprising decision was because the injured worker wanted to have an IDET procedure…and the hearing officer said this was “not a spinal surgery.” Yet, the employer (who was self-insured)—as established by the work comp attorneys— had earlier seemed to have agreed to the procedure as “surgery.” The Medical Review Division issued a notice to the self-insured that it was liable for the cost of the procedure. It was not until after notice that the self-insured employer argued that IDET was somehow not “spinal surgery.”
The injured worker had an undisputed lumbar herniation that caused considerable pain. While his treating doctor recommended fusion surgery, the doctor was willing to try the less drastic Intra-Discal Electro Thermal treatment (IDET) procedure, because the injured worker wanted to try a less invasive procedure first. According to an article from the employer itself, the IDET procedure even cost an average of 17% less than what open spinal surgery costs.
The work comp attorneys developed a series of definitions and descriptions, to show IDET is a surgery. The IDET procedure is performed on the spine. The parties had even agreed, and the medical literature introduced by the attorney showed, IDET is a “surgical procedure.” Plainly, the attorney argued, “surgery” includes less invasive procedures than open operations involving general anesthesia, and is broad enough to include procedures that would occur in a doctor’s office. The work comp attorneys also introduced evidence that an IDET procedure involves a catheter into the disc under local, (versus general) anesthesia. The employer argued that the second opinion doctors describe the IDET as an “alternative” to surgery. Instead, the lawyer showed they actually described IDET as an alternative to a fusion procedure, not to “surgery.” The attorney showed that the worker’s second opinion doctor actually said that “his surgery” (the IDET) had not yet been scheduled. Likewise, the self insured’s own selected doctor never said that the IDET procedure wasn’t surgery. In fact, the lawyer established, he really said it was an “operative intervention.” This, the work comp attorneys pointed out, was simply ‘surgery’ by another name.
The idea of being a “surgery” or not, should have been common sense. But this illustrates why people need to at least talk with the right work comp attorneys. The Board agreed with the worker’s lawyer that the employer was liable for the cost of the recommended spinal procedure, and that it was surgical. The Board ordered that the self-insured employer pay for the costs of the IDET surgery.
Texas lawyers are especially knowledgeable of the in’s and out’s of worker injury cases. By consulting with the work comp attorneys, a case may be literally saved. In this instance, even a hearings officer misapplied Texas compensation law. Working with a work comp attorneys firm almost certainly resulted in preserving medical rights and even a future ability to work. For anyone injured at work, it is almost always essential to consult with a workers compensation-qualified lawyer, as soon as possible.