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Is A Chronic Pain Management Program Reasonable And Necessary Medical Treatment For The Compensable Injury?

Case Conclusion Date: 10.28.2008

Practice Area: Workers Compensation

Outcome: Settlement

Description: K.W.'s treating doctor recommended that she attend a chronic pain managment program. The workers' compensation insurance carrier denied preauthorization for these services alleging that it was not reasonable and necessary medical treatment. The Division of Workers' Compensation assigned an independent review organization to consider the medical necessity of these services. That review determined that the services were medically necessary, and the carrier appealed that decision to a Medical Contested Case Hearing. At the pre-hearing conference, the parties were not able to resolve the dispute. The carrier indicated that it had hired Dr. Melissa Tonn to testify that the program was not medically necessary. Just prior to the hearing to resolve this matter, the parties were able to reach an agreement. The parties agreed that the chronic pain management program was medically necessary. Additionally, the doctor agreed that he would reduce his bill by 20% for the first ten days of the program to facilitate the agreement.

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