Greetings, nothing frustrates an adjuster more than when it appears a new and unrelated body parts is getting added to a claim. You have a compensable wrist injury, and then you get a request for cervical MRI, or you have a foot injury and the doctor asks for bloodwork, lumbar MRI for a hip injury, etc…
Often this is the doctor trying to find another potential cause of the symptoms other than your mechanism of injury.
There is a long line of caselaw that basically says if the purpose of a diagnostic test is to “rule in or rule out” whether a condition is compensable, the claimant does not need to prove the accident is the Major Contributing Cause of the testing first. Attached is one of the more recent cases, and the 1st DCA states:
“A claimant must establish a causal relationship between his injury and the compensable accident in order to secure treatment, but not to be entitled to diagnostic testing to determine the cause of his symptoms.” Grainger, 869 So.2d at 1271 (emphasis in original). “Whenever the purpose of the diagnostic test is to determine the cause of a claimant’s symptoms, which symptoms may be related to a compensable accident, the cost of the diagnostic test is compensable.” Nealy v. City of W. Palm Beach, 491 So.2d 585, 586 (Fla. 1st DCA 1986). “This is true even though it should later be determined that the claimant suffered from both compensable and non-compensable conditions.” Id.
Thus, the MCC standard should not have been applied to bar Claimant from receiving an additional diagnostic test to determine the cause of her symptoms.”
However, to be safe and avoid accidently accepting a condition under the 120- day rule by arguably providing treatment, you should state in the authorization that for example, the cervical condition is not compensable, the MRI is authorized for rule in/rule out purposes. You could even go so far as to issue a DWC-12 denial of the cervical condition, and state the MRI is only for rule in/rule out purposes.
This logic goes beyond diagnostic tests, and arguably applies to diagnostic injections and some treatments, even if there are also therapeutic benefits to it as well. On these, for certain I would recommend the authorization be clear and a DWC-12 be filed so you don’t buy something you don’t want.
As always, feel free to reach out if you have any questions!
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Sincerely,
Morgan Indek | Managing Partner