Often, we have to treat a claimant’s underlying personal health condition to get it under control so they can treat for our compensable WC injury. The treatment of personal health conditions would fall under the Hindrance to recovery theory, and common unrelated conditions we see include uncontrolled diabetes, high blood pressure, weight-loss and smoking.
We are only responsible for treating the condition to the point where the claimant can be cleared for the compensable WC treatment, such as surgery or injections. After clearance is obtained, we are no longer responsible for treatment. Unfortunately, we could be responsible for any temporary indemnity due while the treatment for the unrelated personal health condition is occurring, if there are work restrictions from the compensable injuries that the employer cannot accommodate.
Recently I have had a few questions/concerns about “getting stuck” with the unrelated personal health condition. Under the 120 day rule, if you start treating a condition and do not deny it within 120 days, you have accepted that condition as compensable. To avoid this situation, I recommend two steps be taken:
- The authorization letter to the doctor should be specific, that treatment is authorized of the unrelated health condition only to the extent necessary to obtain medical clearance, and no further treatment beyond that point is authorized; and
- File a DWC-12 Notice of Denial of the condition at the same time, stating the personal health condition is denied, but treatment is authorized only to the extent necessary to obtain medical clearance for the specific WC treatment at issue (surgery, injections, etc…)
This will make it clear that you have not accepted the unrelated personal health condition on a permanent basis.
As always if you have any questions, please let me know.
Morgan Indek | Managing Partner