By Mary F. Hannon, Attorney at Law
The Board of Industrial Insurance Appeals recently issued a decision providing further clarity in terms of how Maphet applies in situations where an employer authorizes treatment that the worker never pursues.
On December 30, 2024, the Board issued a Decision and Order affirming a Department reopening order. The employer argued that because the worker never underwent an authorized L4-L5 total disc replacement surgery to treat preexisting lumbar degenerative disc disease, the Maphet decision did not apply and it was not responsible for the underlying and preexisting lumbar degenerative disc disease. The worker was unable to proceed with the surgery at the time it was authorized by the employer due to obesity. The Department eventually closed the claim in March 2022, but thereafter reopened the claim in October 2022.
The Board ultimately disagreed with the employer’s argument that it was not responsible for lumbar degenerative disc disease because the worker did not proceed with the lumbar spine surgery. The Board concluded that Maphet, in fact, applied and there was objective worsening of an accepted condition. In other words, by authorizing the L4-L5 total disc replacement surgery, the employer had accepted the underlying condition, or aggravation of preexisting lumbar degenerative disc disease.
In Maphet, the Washington Court of Appeals found that, “if a self-insured employer authorizes [treatment], the self-insured employer has accepted the condition and not just consequential treatment.” We previously discussed the impact of Maphet as well as highlighting more recent decisions which limited its reach. See here and here. In Brownlee, the Board reaffirmed the reach of Maphet in confirming that an employer’s authorization of specific treatment under a claim will be deemed acceptance of the underlying condition that the treatment is meant to address, or, in this case, aggravation of preexisting lumbar degenerative disc disease. A different outcome may have resulted had the employer either denied the authorization request outright, perhaps based on medical evidence or pending an independent medical examination, or, alternatively, provided limiting language in the authorization letter as to the accepted condition.
Although the Brownlee decision is not currently considered a significant decision by the Board, nor is it clear whether this decision will be overturned by a reviewing court, it is an important case study in further confirming the impact of Maphet and ensuring all necessary investigation is done before an employer authorizes treatment under a claim. In the event specific treatment is authorized but not pursued by the worker, it remains to be seen whether remedial efforts by the employer could cure the previous treatment authorization.
As always, please do not hesitate to contact the attorneys at Reinisch Wilson P.C. with any questions you may have about authorizing treatment or the Brownlee or Maphet cases.