An environmental inspector who was injured in a car accident in 2002 and continues to suffer pain and other issues will no longer receive a number of medications, including two opioids, after medical testimony raised concerns over addiction and that the pills were not resulting in his improvement, an appeals court in West Virginia ruled Friday.
The Office of Judges in 2019 affirmed a claims administrator’s denial of a request for two opioids, a nerve-pain patch and a muscle relaxer for Richard Kennedy, finding that “the medication request was not submitted and that the record contains no other medical evidence from a treating physician indicating the medications are reasonable and necessary for the compensable injury,” according to documents in Richard Kennedy v. West Virginia Office of Insurance Commissioner and WV Division of Environmental Protection, filed in the Supreme Court of Appeals of West Virginia in Charleston.
The Office of Judges found that the only physicians of record to address the request both opined that Mr. Kennedy should be weaned from the opioids Hydromorphone and Oxymorphone, ruling that the prescriptions “far exceeded the treatment guidelines and there was no evidence indicating the requesting physician completed the documentation required for treatment beyond the guidelines.”
Further, the Office of Judges found that Mr. Kennedy did not show that his condition substantially improved in the 10 years that he was treated with opioid medications, as required by state regulation, and that a “wean and taper plan” had already been completed.
Regarding Lidoderm patches and the muscle relaxer Tizanidine, the Office of Judges agreed with medical opinion that “neither medication was reasonably required or necessary treatment for the compensable injury.”
The Board of Review affirmed, as did the appeals court, writing that a “preponderance of the evidence fails to show that the requested medications are medically necessary or reasonably related treatment for the compensable injury.”
