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Messitte v. Liberty Mutual Fire Insurance Company8/31/2001
ined claimant was not at MMI because "at no time did this patient receive trigger point injections as part of the treatment plan." (Id. at 9.) He recommended trigger point injections as "curative," not merely "palliative." (Id.)
Claimant began a course of Lidocaine and saline injections with Dr. Brown. (Id. at 10.) Reports of progress during April were equivocal. (Id. at 11-13.) At deposition, Dr. Brown testified that he thought the injections were working because claimant's pain patterns were changing. However, on May 6, 1998, claimant told him there was "essentially no change" except for "more soreness and pain." (Id. at 14.) Dr. Brown concluded claimant was "not responding to her trigger point injections" and that she should "discontinue physical therapy." (Id.) At that point, he concluded exercise was the key to her condition, recommending "a gym membership to supplement the patient's home exercise program." He considered her "present residuals" to be "permanent." (Id.)
During July 1998, claimant sent the insurer Dr. Brown's prescription for ongoing massage therapy, noting: "I'm attempting to find a massage therapist and time in my schedule for this." (Id. at 15.) During August 1998, claimant began receiving massage therapy at $75 per session. (Id. at 18.)
On September 9, 1998, Dr. Brown opined that claimant's "present condition is causally related to her work at Glacier Park in June of 1991." (Id. at 19.) He wrote:
It is the nature of her diagnosis (fibromyalgia) that any static condition, and/or any muscular force can cause increased symptomatology. Therefore, any employment would cause an increase in symptomatology, and not her specific employment at this time. The patient has been able to continue working at her present job description. (Id.)
Dr. Brown told the insurer fibromyalgia patients were "always at risk for recurrences and exacerbations," making it "inevitable that she will require repeat treatment." (Id.) He noted:
The patient is presently receiving medical massage. Without some type of ongoing treatment, this patient's functionability will distinctly decrease, which may result in increased loss time. I can not give you a specific time frame, in relation to her treatment plan. Again, it is the nature of her underlying diagnosis to have exacerbations and remissions, though it is rear to return to a pain free state. (Id.)
Because claimant's diagnosis was not "curable," Dr. Brown opined that "without the treatment plan noted above (massage and health club), the patient will significantly regress, and therefore, will have increased loss time." (Id. at 20.) It was his "medical opinion that she will require ongoing medical massage, and the use of a health club." (Id.รท
On November 17, 1998, claimant told Dr. Brown that "with working 12 to 14 hour days, her pain is significantly intensifying." (Id. at 21.) She was considering quitting employment in January of 1999. Because the insurer had not been covering massage or gym membership, Dr. Brown wrote:
It is not practical for this patient to do only a home exercise program. Without her ongoing exercise program, this patient will have a regression and will then require a more restorative type program. Though fibromyalgia is chronic in nature, there is no "cure," the treatment plan outlined above is considered standard treatment for this entity. (Id. at 21.)
On December 9, 1998, Dr. Brown recorded that claimant was "working between 14-16 hours per day as well as weekends secondary to down sizing at her facility. She states that this has caused significant increased pain and dysfunction." (Id. at 22.) She planned a
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