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Walter West, Jr. v. Wal-Mart Stores, Inc., IAB Hearing No. 1305971 (January 12, 2011)

Claimant filed Petitions to Determine Additional Compensation Due appealing a Utilization Review decision for treatment allegedly related to an acknowledged, July 2007, low back injury. Although the Utilization Review decision was favorable to Employer, both Claimant's and Employer's expert witnesses agreed that the treatment at issue fell within the Health Care Practice Guidelines. Employer conceded that the medical bills at issue were reasonable and necessary. Employer intended to defend the Petitions on the ground that the treatment was not causally related to the work accident. Employer's causation argument was premised upon a gap in medical treatment for over two years following the acknowledged work injury. Following opening statements, Claimant made a motion for summary judgment on the basis that Employer's submission of the medical bills in question to Utilization Review constituted an acknowledgement of the causal relationship of the treatment to the work-related injury. The Board agreed that by submitting the medical expenses to Utilization Review, Employer waived its right to argue causal relationship. Further, since Employer had conceded reasonableness and necessity to the expenses, summary judgment was granted in Claimant's favor.


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