Mason v. State of Delaware, IAB Hearing No. 1198102 (January 15, 2010)
Claimant filed a Petition to Determine Additional Compensation Due, seeking payment of medical and mileage expenses, including expenses for massage therapy. Employer objected to the massage therapy expenses on the ground that the therapist was not certified and did not obtain pre-authorization for the treatment. Alternatively, Employer argued that the massage therapy was not reasonable and necessary treatment and/or was outside the Health Care Practice Guidelines applicable to Claimant's injury. The massage therapist, a Delaware provider, did not obtain certification until two weeks prior to the hearing. Further, the certification was obtained approximately two months after the last date of service for the massage therapy expenses at issue under the Petition.
The Board held that the massage therapy treatment at issue was not compensable. Citing its prior decision in Bertha Polk v. Green Acres Pavilion, IAB Hearing No, 1253843 (Dec. 4, 2009), it noted that Section 2322C(6) of the Workers' Compensation Act seems to suggest that non-certified providers, without pre-authorization, may seek payment for medical services if they can establish that the treatment is reasonable and necessary at a hearing before the Board. However, after reviewing the legislative history for Section 2322D, the Board concluded that when treatment is provided by a Delaware medical provider, the provider must be certified or obtain pre-authorization from the employer or insurer to seek payment for services through the Delaware workers' compensation system. The Board distinguished the Polk case, noting that it involved treatment provided by an out-of-state provider over which the State of Delaware lacked jurisdiction. Further, it noted that the Claimant in Polk could not reasonably be expected to continue treating with a Delaware medical provider after relocating to North Carolina. Finally, the Board held that, even if the massage therapist had been duly certified, the treatment she rendered was not reasonable and necessary in this case.