The Delaware Supreme Court on Thursday reversed a trial judge’s decision that found ongoing narcotics treatment for an injured construction worker was proper.
The high court determined a Superior Court judge wrongly reversed an Industrial Accident Board decision regarding the reasonableness of narcotics treatment for Raymond Nieves, who sustained a back injury in July 2014 while working on a construction project for This and That Services Co. Inc.
The employer disagreed with a utilization reviewer’s finding that the ongoing course of treatment was necessary, and it petitioned the board to limit the amount of time it was required to pay for the treatment.
The board ultimately dismissed the petition as moot since the company already paid for the narcotics.
The Superior Court reversed the board’s decision, finding no evidence existed that the employer paid for the medication.
The trial court also wrongly found the company couldn’t seek board review of the ongoing narcotics treatment before first submitting each prescription to utilization review, the high court wrote.
“In the Superior Court’s view, when new or subsequent claims are made, the employer must return to utilization review, even when each claim relates to the ongoing treatment that was originally sent to utilization review,” the court wrote. “That conclusion is inconsistent with this case’s facts (and) the purpose of the utilization review process.”
The high court said the board’s findings that the ongoing narcotic medication treatment was unreasonable and unnecessary were supported by “substantial evidence.”