Fatal claim petition granted for death of claimant from overdose of medications that were previously found to be neither reasonable nor necessary.

This case has been a hot topic of conversation in the Pennsylvania workers’ compensation community. It involved the death of a claimant from an overdose of medications that had been prescribed to him by his treating provider. Two weeks before the claimant's death, a Utilization Review Determination (UR) was issued, concluding that all of the provider's treatment, including prescriptions, was neither reasonable nor necessary. After the UR was issued, the provider tried to prescribe medications, but the pharmacy refused to fill them. The provider then told his sister, a physician in his practice, that the pharmacy would not fill the claimant's prescriptions because of the UR and asked her to handle the situation. She then saw the claimant and prescribed medications for him. Two days later, the claimant passed away from overdosing on the medications.

The Commonwealth Court affirmed the Workers' Compensation Judge's decision granting a fatal claim petition, holding that the issue of causation was separate and distinct from the reasonableness and necessity of medical treatment. In the court's view, the prior UR concerned only reasonableness and necessity of treatment and was irrelevant in determining whether the claimant's death was causally related to his work-related injury.

Case Law Alert - 2nd Qtr 2012