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Meyers v. Western Auto6/6/2002
surgery on December 17, 1998. Just prior to the surgery, Worker's wife informed Ramirez that the IME would have to be rescheduled once again. Ramirez told her that after December 31, 1998, CNA would terminate medical benefits until an IME report was received. On January 29, 1999, the surgeon who had operated on Worker in December 1998 released Worker to travel. CNA was notified of the release and the IME was scheduled for March 26, 1999. In the meantime, Worker informed his treating physician in Nevada, Dr. Parker, that Worker's benefits had been stopped. Dr. Parker wrote to Ramirez on February 4, 1999, informing him that Worker continued to need medical treatment for his back and that the back condition was not related to the neck and shoulder injuries sustained in September 1998. Dr. Parker urged CNA to reinstate Worker's medical benefits. Thereafter, Worker's wife called Ramirez and informed him that Worker's condition was deteriorating and that Worker could not afford to pay for his medications. Ramirez told her that he did not need to respond to Dr. Parker's letter, and advised her that the benefits remained suspended until after the IME.
In an effort to address his ongoing back pain, Worker underwent a selective nerve root block, performed by Dr. Parker on March 22, 1999. CNA denied payment for this procedure. On March 26, 1999, Worker attended his IME in Albuquerque, with Dr. Theodore Scharf acting as coordinator. The IME report recommended discontinuation of the pain medication oxycontin, to be replaced by methadone. The report also recommended against nerve blocks. By letter dated April 19, 1999, CNA, through Ramirez, notified Worker that his medical benefits would be limited to those authorized by the IME report. In response, Dr. Parker sent a letter dated April 29, 1999, to inform CNA that methadone had proved unsuccessful in treating Worker in the past, that oxycontin was effective and medically necessary, and that Worker had treatment needs beyond those recommended by the IME report. Ramirez did not respond to the letter and later informed Worker's wife that he would restrict benefits to the IME report recommendations unless otherwise authorized by Dr. Scharf.
Worker brought this dispute to the WCA by filing an application for benefits on July 26, 1999. The WCJ referred the matter to mediation and ordered Dr. Sidney Schultz, a board certified orthopedic surgeon, to perform an IME. The IME report was issued on September 15, 1999. The report and Dr. Schultz's subsequent testimony in this case largely concurred with Dr. Parker's opinions on the use of oxycontin and need for on going pain management at Dr. Parker's discretion. Dr. Schultz also agreed that the injuries Worker sustained in September 1998 should not affect treatment for his back condition.
Ramirez was no longer working for CNA by January 1, 2000. In late January, Worker's pharmacist attempted to contact Ramirez for authorization to fill Worker's prescriptions. First, the pharmacist was advised that Ramirez's voice mail was full; then he was advised that Ramirez was no longer with CNA and directed to leave a message. The pharmacist still had not received authorization from CNA by the time of the hearing on Worker's benefit application in August 2000.
Before the hearing, Worker made an offer to settle the claim, which CNA rejected. At the hearing, Ramirez essentially conceded that he had handled Worker's claim improperly and that it had been inappropriate to discontinue Worker's benefits in December 1998. After the hearing, the WCJ entered an order that had the effect of back-dating all medical benefits to December 1998, including most of Dr. Parker's treatments and prescription recommendat
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