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Central Highway Oil Co. v. Workers' Compensation Appeal Board3/18/1999
Submitted: January 22, 1999
Central Highway Oil Company (Employer) petitions this Court for review of a Workers' Compensation Appeal Board (Board) order that reversed a Workers' Compensation Judge's (WCJ) decision to deny Joseph Mahmod's (Claimant) utilization review petition pursuant to Pennsylvania's Workers' Compensation Act (Act), Act of June 2, 1915, P.L. 736, as amended, 77 P.S. ยงยง1-1041.4; 2501-2626.
Claimant sustained an injury during the course of his employment while delivering oil to a residence on February 9, 1994. On December 14, 1995, Employer filed a request for utilization review in an effort to determine the reasonableness and medical necessity of the chiropractic care prescribed and provided to Claimant by Wilbur B. Kenesky, D.C. on and after November 10, 1994. W. Brett Carothers, D.C. conducted the utilization review for Employer. After reviewing Claimant's medical records, Dr. Carothers indicated: "Neither the reasonableness or medical necessity of continuing the care as prescribed and delivered is substantiated beyond February 9, 1995, in this instance." However, Dr. Carothers opined that extended care was reasonable beyond November 10, 1994 until February 9, 1995.
On January 27, 1996, Phillip A. Richter, D.C. completed a utilization review reconsideration of Claimant's post-injury chiropractic care in Dr. Kenesky's facility. Dr. Richter opined that care through early 1995 could be reasonably supported. However, he found that treatment subsequent to May 30, 1995 could not be supported due to the lack of subsequent attempts at structured in-house active care in accordance with support-of-care guidelines.
On or about February 27, 1996, Claimant filed a petition for review of utilization review determination seeking a determination of the reasonableness or necessity of the treatment provided by Dr. Kenesky. Following a hearing, the WCJ found that Employer had met its burden of proving that the chiropractic care provided by Dr. Kenesky after February 9, 1995 was unreasonable or unnecessary, and he denied Claimant's petition. On Claimant's appeal, the Board reversed the WCJ's decision. Employer now appeals to this Court.
Our scope of review is limited to determining whether constitutional rights were violated, errors of law were committed or necessary findings of fact were unsupported by substantial evidence. Crenshaw v. Workmen's Compensation Appeal Board (Hussey Copper), 645 A.2d 957 (Pa. Cmwlth. 1994). There is no doubt that the WCJ is the sole Judge of questions of credibility and may accept or reject the testimony of any witness in whole or in part. Id. We cannot disturb findings of the WCJ, even if there is evidence to the contrary, if those findings are supported by substantial evidence. Id.
Employer raises two arguments before us. First, it contends that the Board erred when it held that the standard of reasonable care employed by the WCJ was erroneous as a matter of law. In essence, Employer argues that the Board erred when it held that reasonable care, as defined in Section 531 of the Act, can include treatment for the relief of pain absent a decrease in a claimant's physical incapacity as a matter of law. We disagree.
The WCJ in his decision put forth the following standard for reasonable care involving treatment for pain:
" his WCJ concludes that in order for the treatment of Dr. Kenesky to have been considered reasonable medical treatment, this WCJ would have needed to have found that the chiropractic treatment at issue would have resulted in a decrease in the Claimant's incapacity. In other words, the Defendant was entitled to the relief sought if it proved by a preponderance of
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