Medical Treatment: CRB Affirms Employer's Responsibility For Cardiac Evaluation Bills After Chest Injury

In March of 2005, Claimant Edit Pue sustained injuries while working to her shoulder, breast bone and rib cage. Her case was accepted by her employer as compensable.

Two weeks later, after experiencing chest pains, the Claimant presented to the Emergency Room where, hearing a complaint of chest pain, the ER docs set her up for a full cardiac evaluation---good medicine.

Sadly, the WC carrier did not see it that way and refused to pay the bills for this and several subsequent ER evaluations for chest pain.

At trial, the Commissioner ordered the respondents to pay for these bills. Thereafter the Employer appealed to our Compensation Review Board.

The CRB decision, released on August 22nd holds:

the fact that the medical personnel at (the ER) referred the claimant for a cardiac diagnostic work-up supports an inference that the referral was reasonable medical treatment. Such action was consistent with accepted medical procedures in instances where a patient complains of chest and left arm pain and should satisfy the statute’s requirements as to what constitutes reasonable and necessary medical treatment. That inference is further buttressed by the opinion of the respondents’ examiner, Dr. Edward Staub, indicating that when a patient complains of chest pain the proper medical protocol is to rule out a heart condition. See Findings, ¶¶ 33, 34, and X, Y, FF, GG. The claimant’s complaint of pain in her chest and related body parts was the causal impetus for the claimant’s visit to the ER. Those complaints were ultimately diagnosed as a medical condition causally related to her March 1, 2005 injury. It therefore logically follows that diagnostic testing consistent with established medical procedures to determine what was the source of claimant’s pain constitutes reasonable and necessary medical care.

Hooray for the CRB on this one, as this is a more frequent than you might expect scenario. The complete decision can be read here.