payaat

An employer was not required to consent to a change of physicians where claimant, who sustained a pulmonary injury and initially chose to see a physician who was not a pulmonary specialist, later decided to undergo treatment from a pulmonary specialist, because the initial physician sent claimant to other specialists skilled in treating pulmonary injuries, and thus the initial physician provided the care of a specialist whose services are necessary for the proper care and treatment of the compensable injury pursuant to Section 7(b) and 20 C.F.R. §702.406(a). Senegal v. Strachan Shipping Co., 21 BRBS 8 (1988). Section 7(b) and its accompanying regulation, 20 C.F.R. §702.407, address the authority of the Secretary and the deputy commissioners to oversee an injured employee's medical care. The provisions, do not, however, address the issue of payment or reimbursement, which is governed by Section 7(d). Thus, where employer refuses to authorize a change in physician, claimant is entitl...

Where the administrative law judge found, based on a doctor's opinion, that claimant would be "better off" remaining with his family than being cared for in a nursing home, the Board rejected employer’s argument that it should be liable only for the costs of nursing home care and affirmed the administrative law judge’s decision holding employer responsible for paying for home health care services, as employer is liable for the costs of keeping claimant at home. The Board also affirmed the administrative law judge's conclusion that employer must reimburse claimant's wife for home health care services she paid for in excess of 8 hours per day because there is no evidence that the parties' informal agreement that employer was liable for only 8 hours of care per day was approved by a deputy commissioner or administrative law judge. Falcone v. General Dynamics Corp., 21 BRBS 145 (1988). The Board affirmed the administrative law judge's finding that modification...

The Board remanded the case for the administrative law judge to address the proximity of a physician's office to claimant's residence in determining whether claimant was entitled to the services of Dr. LaRocca, a Board-certified orthopedic surgeon to whom claimant was referred by her treating physician, as Dr. LaRocca's practice is some 313 miles distant from claimant's home, employer offered the services of a nearby specialist and Section 702.403 provides that 25 miles is generally a reasonable travel distance for medical care. Welch v. Pennzoil Co., 23 BRBS 395 (1990). The Board affirmed the denial of medical benefits where the administrative law judge rationally found that the doctor's treatment was duplicative of the treatment claimant was receiving from other doctors and therefore was unnecessary. Hunt v. Newport News Shipbuilding & Dry Dock Co., 28 BRBS 364 (1994), aff'd mem., 61 F.3d 900 (4th Cir. 1995). The Board affirmed the administrative law judge...

The Board remanded the case to the administrative law judge for a determination of whether claimant's hearing loss is work-related; if so, claimant is entitled to medical benefits for a neck injury sustained during the course of a medical examination for the hearing loss. Weber v. Seattle Crescent Container Corp., 19 BRBS 146 (1986). Where relevant evidence establishes that claimant's psychological condition was caused, at least in part, by her work injury, and that she was treated, at least in part, for her workrelated condition, claimant is entitled to benefits for this treatment. The Board also held that there is no evidence to support the administrative law judge's conclusion that the degree of claimant's pain is not sufficient to justify psychological services. The Board accordingly remanded for the administrative law judge to enter an award of medical benefits for those expenses deemed reasonable and necessary for treatment of claimant's psychological conditio...

The right to reimbursement  of medical costs to a carrier providing non-occupational disease coverage (an intervenor) for a condition ultimately determined to be occupationally-related, is solely derivative of claimant's right to reimbursement of such expenses under Section 7. Section 7 provides the exclusive means of holding employer liable for medical benefits and contains no provisions granting non-occupational carriers an independent right to reimbursement. As claimant did not comply with the requirements of Section 7(d), the administrative law judge’s finding that the intervenor could not be reimbursed was affirmed Ozene v. Crescent Wharf & Warehouse Co., 19 BRBS 9 (1986). Claimant has no standing to assert Medi-Cal's rights to reimbursement for medical services it provided to claimant. Quintana v. Crescent Wharf & Warehouse Co., 18 BRBS 254 (1986), modified on recon., 19 BRBS 52 (1986). On reconsideration, the Board modified this decision, holding that the adminis...