WCDefenseCA

Happy Monday, dear readers!

Your humble blogger is back at it with a spring in his step and a song in his heart, denying benefits with the left hand and defeating liens with the right.  But, life being so sweet has given this care-free defense attorney a proverbial tooth-ache, so a workers’ compensation post touching on dental treatment is absolutely appropriate.

Recently, the Court of Appeal denied review following a split panel’s decision on an applicant’s claim of right to medical treatment in the form of dental care.

Applicant sustained an admitted injury on June 1, 2004, when she was assaulted by a psychiatric patient.  She sustained injury to various body parts including her tooth and head.  The claim was the subject of an award, issued in February of 2013, which included future medical care for, among other body parts, the tooth and head.  Down the road, a dentist requested authorization to extract tooth 18 and insert a cantilever bridge anchored on tooth 19 and tooth 20.  The treating dentist noted that the fracture to tooth no. 18 was NOT an industrial injury, but its extraction was necessary to fit a bridge on 19 and 20, thereby relieving the symptoms of the industrial injury.

At trial on the dental treatment issue, defendant argued that tooth 18 was not hurt during the original injury, and so was excluded from a future medical award.  The WCJ rejected applicant’s claims, reasoning “[w]hat remains is an effort to bootstrap ‘tooth’ into any dental care that Applicant might require.  Such an effort does not constitute a valid basis for imposing Applicant’s current dental problems upon this employer.”

The WCAB majority concurred that it was too late, more than 5 years after the date of injury, to amend the WCJ’s original award to include all the dental care one could imagine.

My dear readers can probably attest to the fact that dental care can get expensive, especially when the worker chips a tooth for his or her employer, and the employer eats the entire mouth.

The dissent took the position that the unrebutted evidence was that the dentist’s proposed treatment was a prerequisite for treatment of the entire mouth and jaw, and that, as the jaw was part of the “head,” treatment should have been provided under applicant’s future medical award.

Your humble blogger would like to submit that his reading of the available information of this case was that we have something rare before our eyes – a common sense result.  Applicant chipped her tooth during the assault and the future medical care was for the tooth she chipped.

Had she been entitled to future medical care for her lumbar spine, labeled as “back” on an award, that treatment would not have included treatment for skin cancer due to sun exposure to her back.

Nor does an award for future medical care entitle her to treatment for hearing loss, just because her ears (and her hearing) are part of her head.

But, don’t just “get it and forget it,” dear readers – this case could have gone the other way.  Let this be a reminder to us all to be precise in our language when settling our claims with future medical awards to be left open – let us describe in detail the body part injured and the NATURE of the injury.  Future medical care for one harm does not mean future medical care for all harms, right?

Now go out there and get em!