THERE IS NO JOY FOR THE INJURED WORKER IN THE JOY CASE

A recent Court of Appeals decision, Joy v. Department of Labor and Industries, held that as a matter of law, an injured worker is unable to obtain medical procedures that are precluded by the Health Technology Clinical Committee (HTCC).  The HTCC is a committee of 11 practicing health care professionals who review scientific, evidence based reports about whether certain medical devices, procedures and tests are safe and work as promoted.  The HTCC determines whether certain types of treatment will be covered under a State purchased health care program, regardless of the individual facts and circumstances.  This includes workers compensation claims.  Read a review of their health technology assessment findings here.

In the Joy case, the injured worker sought review of a decision of the Board of Industrial Insurance Appeals to deny payments for a spinal cord stimulator to treat her workplace neck injury.

After the HTCC issued its determination that spinal cord stimulation is not proper for anyone covered under a State sponsored plan, the court determined the Board of Industrial Insurance Appeals does not have jurisdiction to make a different individual determination whether the treatment was medically necessary and proper for that individual.

If the HTCC has not acted to forbid a specific treatment or modality of treatment for coverage, the Department of Labor and Industries, and Board of Industrial Insurance Appeals are authorized to make coverage determinations.

Dane D. Ostrander 

Williams, Wyckoff & Ostrander, PLLC