Illinois employer must pay for discogram, IDET despite recommendations in utilization review
The Illinois Workers' Compensation Commission modifies the arbitrator's decision in which he awarded 21 weeks of temporary total disability benefits for the worker's low back disability. Despite the recommendations set forth in a utilization review, the Commission found the defendant liable for the cost of a discogram and an intradiscal electrothermic therapy (IDET) procedure.
Case name: Garcia v. Executive Mailing Service, 17 ILWCLB 103 (Ill.W.C.Comm.2009).
Summary: Garcia injured his back while working as a forklift operator. His doctor indicated that an MRI revealed two small disc herniations while the employer's evaluating doctor opined that Garcia had small bulges but no herniations. He received a variety of treatments without any long-term benefits. The arbitrator awarded 21 weeks of temporary total disability benefits but denied certain medical expenses based on utilization reports. Pursuant to the utilization reviews, the arbitrator denied the cost of physical therapy after Feb. 25, 2008, transforaminal injections, IDET procedures, discogram and facet injections. However, the arbitrator found compensable the reasonable cost of evaluations, examinations, a lumber medial branch block, and other treatment. Upon review, the Commission modified the arbitrator's decision to require the defendant to pay for the discogram and IDET procedures.
The Commission noted that while utilization review reports are relevant, they are not intended necessarily to be dispositive. Rather, the reports should be treated as evidence to be assessed just like all other evidence. Also, the Commission found that the untilization review criteria regarding the recommended discogram and IDET procedure "may be a bit too strict." The utilization review appeared to discount IDET completely as a certifiable treatment because of the lack of precise proof of its efficacy. Also, the Commission noted that the basis for rejecting the discogram, because of the lack of "documentation of consistent and overwhelming evidence" of pathology, appears to be unduly rigid, as the discogram is primarily a diagnostic tool. It would be difficult to establish " consistent and overwhelming evidence" of pathology without a discogram.
