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Moore v. K-Mart – Occupational Illness and Reimbursement for Medical Costs

The concept of workers’ compensation benefits is most often associated with work-related injuries. But occupational illness are equally as pervasive and can be just as serious.
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The Centers for Disease Control and Prevention estimates between 26,000 and 72,000 deaths occur annually in the U.S. as the result of occupational diseases. The U.S. Bureau of Labor Statistics estimates approximately 300,000 new work-related illnesses occur annually. These run the gamut, from occupational cancers like mesothelioma to work-related heart disease to negative impacts on reproductive health.

Establishing a link between a worker’s condition and his or her job can be challenging, particularly when there is a period of latency between the exposure to illness-causing agents and development of the disease. But making this connection is critical to ensuring the person affected can obtain workers’ compensation benefits.

An example of this was recently underscored in the recent West Virginia Supreme Court case of Moore v. K-Mart, wherein a worker sought reimbursement of medical expenses related to treatment of occupational disease caused by toxic exposure to heavy metals.

According to court records, claimant worked for the same employer for three decades. During that time, her duties included using belt sanders and grinders to refurbish furniture. Her days were spent in a small room with poor ventilation, which trapped furniture and metal dust.

Worker began to develop feelings of numbness and tingling in her feet. Then they began to burn and she would later describe the feeling as “crushed ice coming out of the bottom.” Her symptoms continued to worsen.

Her treating physician diagnosed her with peripheral neuropathy due to toxic exposure to heavy metals at work. She filed a claim for workers’ compensation benefits and, although the company fought it, the state commission ultimately ruled her condition compensable.

Another doctor later began treating her with a type of therapy known as intravenous chelation. The process involves injecting a synthetic solution into the bloodstream to help remove minerals and heavy metals from the body. Her symptoms began to improve. The physician had extensive experience performing the procedure in his office, and further noted there were no other programs at state hospitals that specialize in treatment of chronic heavy metal toxicity. There was also no dispute that the treatment was medically necessary to treat an undisputed medical condition.

Still, claimant had to fight for reimbursement of those medical expenses.

The insurer denied her request for reimbursement of these expenses based on a state statute indicating the reimbursement for chelation therapy performed in-office is not reimbursable. The case worked its way all the way to the state supreme court, which decided otherwise.

The high court noted the basic purpose of workmen’s compensation legislation is to impose upon industry the cost of medical expenses of workers who suffer severe injuries in the course of employment. The court noted there was no medical rational for the distinction of why this particular therapy had to be performed in a hospital rather than in a doctor’s office. Further, there was no cost-prohibitive reason either. In fact, while the therapy usually costs more than $400 a unit, his office provides it at the discounted rate of just $100 per unit.

The insurer asserted the controversial nature of the therapy as the reason for the statute, but the high court noted controversy was only an issue when the therapy was applied to other conditions – not high metal toxicity.

The court ruled this particular portion of regulation is contradicted by a number of state statutes, namely laws providing for quick, efficient delivery of medical benefits to injured workers. Thus, the court declared the law invalid and ordered patient be reimbursed for her expenses.

If you or someone you love has been injured a Boston work accident, call for a free and confidential appointment at 1-888-367-2900.

Additional Resources:
Moore v. K-Mart, Feb. 5, 2015, Virginia Supreme Court
More Blog Entries:
Moreau v. Transp. Ins. Co.: Workers’ Compensation and Asbestos, Jan. 20, 2015, Boston Workers’ Compensation Attorney Blog