Appeals Board Panel Decision Finds ACOEM Guidelines Not Limited to Acute Care

Richard A. Schryer v. Southern California Edison 9 WCAB Rptr. 10,302 [WCAB No. SBR 0187767]

By Brian S. Grosenbach

In a recent decision by an Appeals Board panel concerning the issue of whether the ACOEM Guidelines apply to treatment of chronic conditions, the WCAB panel found that the ACOEM Guidelines do not necessarily apply only to acute-care medical treatment. Further, it was also found that the ACOEM Guidelines have different sections that apply to different stages of recovery from an injury. Lastly, the ACOEM Guidelines contain general principles that remain applicable without regard to the stage of recovery.

In this particular case, the applicant injured his right shoulder and was initially treated by a physician on a sporadic basis for flare-ups caused by the injury. An award of permanent disability of 9.75% was issued. Further, the award included future medical care. Afterwards, the applicant continued to work his usual and customary job until retirement in 1996. The applicant treated with a chiropractor between November 1994 and January 1996 on an as-needed basis.

Approximately eight years later in 2004 the chiropractor requested authorization for further treatment for the applicant. This request was forwarded to utilization review, which issued a retrospective decision indicating the request was denied on the basis that the treatment did not meet accepted ACOEM Guidelines.

As anticipated, a request for an Expedited Hearing was made by the applicant for medical treatment based upon the chiropractor’s treatment recommendations. The WCJ at the time of the Expedited Hearing issued a finding that the applicant was entitled to further treatment, which of course defendant sought reconsideration contending that the substantial evidence was lacking to support the WCJ’s disregard of the ACOEM Guidelines.

In discussing the applicability of the ACOEM Guidelines the WCAB panel found that various WCJ’s and Appeals Board panels have addressed the issue of ACOEM’s applicability to chronic conditions with disparate and inconclusive results. In particular, the WCAB panel noted that they found no consensus and no clear authority on the issue of applicability of ACOEM Guidelines to treatment of injuries beyond the acute and sub-acute states. Further, the panel considered equally untenable both the blanket assertion that the ACOEM Guidelines do not apply whatsoever beyond 90 days or the assumption that treatment of chronic conditions is governed entirely by Chapters 8-16 of the ACOEM Guidelines.

The WCAB panel agreed in particular with language noted in the Fall 2004 issue of APG Insights, an educational publication of the American College of Occupational and Environmental Medicine in which it states at page 5, “The Guidelines apply at any point following an injury that the principles it espouses, or the information it includes are applicable to the care of the injured worker.”

APPEALS BOARD PANEL DECISION FINDS
ACOEM GUIDELINES NOT LIMITED TO ACUTE CARE

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In conclusion, it was found that in each case, the record will need to be reviewed to determine which stage of recovery is involved, the treatments already attempted and their outcomes, whether the recommended treatment falls within the ACOEM Guidelines including Chapter 6, and if the guidelines contain a negative recommendation, whether a variance is reasonably required.

Therefore, this decision provides defendant employers and carriers insight as to the applicability of the ACOEM Guidelines and in particular provides guidance that the ACOEM Guidelines do not necessarily apply only to acute-care medical treatment.