Installation of an in-home therapy pool held neither reasonable nor necessary treatment where the judge did not consider all of the circumstances, including alternative devices.

The claimant, paralyzed from the waist down following surgery for a work-related back condition, filed a review petition and a Utilization Review request seeking payment for the installation of an aquatic therapy pool at this home, along with the construction of an additional room to house it. Although the claimant was able to return to work full-time in a sedentary job, he had permanent impairment that made it difficult to stand, walk without assistance, transition and dress himself. His treating physician prescribed aquatic therapy, but the claimant complained that the physical therapy facility was busy and he had difficulty getting into the building and navigating the locker room. The Workers' Compensation Judge upheld the claimant's position, finding that the pool installation was reasonable and necessary treatment.

The court, however, reversed that decision, finding that the judge failed to address alternative treatment. In its discussion, the court noted that the claimant is able to travel to physical therapy to obtain aquatic treatment and his concerns about the physical therapy facility are not an impediment to treatment. The court further cautioned that the cost of the proposed appliance and any windfall to the claimant from improvements to his home have to be considered. As a result, the court remanded the case back to the judge, overturned awards for penalties and attorney's fees on this issue, but upheld a penalty for the failure to pay other medical expenses on the basis that the claimant's providers had not submitted medical reports but where the claimant complied with the carrier's instructions in submitting the receipts.

Case Law Alert - 2nd Qtr 2012