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Hamilton v. Gregory Trucking3/16/2005
Henry Hamilton appeals the April 22, 2004, decision of the Workers' Compensation Commission that denied payment of expenses incurred for medications prescribed for him after he sustained a compensable injury to his lower back on May 5, 1995. After conducting a hearing on July 15, 2003, the administrative law judge found that two of the prescription medications were reasonably necessary medical services but that six others were not; additionally, the law judge found that Hamilton was entitled to a change of physicians in the field of pain management. The Workers' Compensation Commission adopted and affirmed the decision of the law judge in a split decision. On appeal Hamilton contends that the Commission erred in determining that the medications, first prescribed by his authorized treating physician and subsequently re-prescribed by other physicians, were not reasonable and necessary. We hold that the Commission erred in determining that these medications were not reasonable and necessary medical services in connection with Hamilton's compensable back injury. Therefore, we reverse and remand the decision of the Commission.
The employer shall promptly provide for an injured employee such medical, surgical, hospital, chiropractic, optometric, podiatric, and nursing services and medicine ... as may be reasonably necessary in connection with the injury received by the employee. Ark. Code Ann. § 11-9-508(a) (Supp. 2003). The employee has the burden of proving by a preponderance of the evidence that medical treatment is reasonable and necessary. Wal-Mart Stores, Inc. v. Brown, 82 Ark. App. 600, 120 S.W.3d 153 (2003). What constitutes reasonably necessary treatment under the statute is a question of fact for the Commission. Dalton v. Allen Eng'g Co., 66 Ark. App. 201, 989 S.W.2d 543 (1999).
Here, the evidence introduced at the hearing included Hamilton's testimony; bills for his prescriptions from June 19, 2001, through March 8, 2002; medical evaluations from the Brackman Family Clinic in Fort Smith from October 21, 2002, until April 4, 2003; and chart records from Dr. Raymond Sorensen at the Pain Institute of Tulsa, dated December 10, 2002, to March 11, 2003. The Commission's decision contained the following findings based upon the evidence presented:
5. The claimant has proven by the greater weight of the credible evidence that outstanding expenses incurred for medication in the form of Amitriptyline and Effexor constitute expenses incurred for reasonably necessary medical services. Pursuant to Ark. Code Ann. § 11-9-508, these expenses are the liability of the respondents herein ....
6. The claimant has failed to prove by the greater weight of the credible evidence that any of the outstanding medical expenses for medication in the form of Oxycontin, Roxicodone, Oxyir, Cloraz Dipot, Metodropramide, and Axid constitute expenses incurred for reasonably necessary medical services, as that term is used in the Act. ...
7. The claimant is entitled to his one time change of physician, pursuant to Ark. Code Ann. § 11-9-514, to Dr. William Money, a chronic pain management specialist in Fayetteville, Arkansas. ...
The Claimant's Testimony
Hamilton testified as follows regarding the medical treatment that he received for his compensable back injury of 1995, beginning with his visit to the emergency room where Dr. Munir Zufari saw him. Dr. Zufari referred Hamilton to Dr. Robert Kale, who administered epidural steroid injections to Hamilton and treated him for about six months until Dr. Landherr performed his back surgery. Hamilton had undergone back surgery prior to 1995, but after the surgery for his compensable injury he went to Dr. Fisher
Page 1 2 3 4 5 Arkansas Personal Injury Attorneys
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