Old Injuries Shouldn’t Be Denied New Medical Services

Nurse and elderly man spending time togetherMedical advancements have changed over the years as have services for people who get sick or who are injured. A ruling on a recent case has proved that benefits have finally caught up with the times, as one worker in Georgia is finally allowed nurse case manager benefits even though at the time of his injury many years ago he was denied that service.

John Ward worked for Pre-Engineer Systems and injured in 1973 when he was working at a construction site and fell 40 feet. He ended up with brain injuries that still give him cognitive impairment. His employer and their insurer paid for a lot of treatments and rehab- but suspended his benefits in 2009. When he tried to reinstate his benefits and sought a nurse case manager, his request was denied so he went to court.

The judge noticed that at the time of his injury, the services of a nurse case manager were not included or expected as part of his benefits. Their services became a benefit in 1975, two years after his claim was handled. But fast forward almost 40 years later, as Ward is facing declining cognitive health and complex medical needs so much that his wife was designated as his guardian. The court believed his argument that he needed a nurse case manager/rehab assistant.

The employer continued to argue that the benefits were not available until 1975 and not in 1973 when his case was settled, so they appealed to the State Board of Workers’ Comp and when they were again denied, they went to the superior court who sided with the employer. Ultimately ending up in appeals court, they took Ward’s side and “retroactively applied (benefits) in those cases which involve pre-existing compensable on-the-job injuries, since to do so would not render compensable an injury which would not otherwise be compensable but would, at most, merely expand the scope of treatment required to be provided for an injury the compensability of which is not in question.” Essentially- they said that pre-existing work injuries should be eligible for these kinds of services even if they were not available before, as they would expand the treatment options available to the worker. They ruled that there is nothing wrong with granting them now.

 

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