Leann Cheney (name changed for confidentially) was injured in the course of her employment in Lewisberry, PA. Indemnity Insurance Company of North America, the workers’ compensation insurance carrier issued a Medical-only Notice of Temporary Compensation Payable (NTCP) on November 12, 2014 for Ms. Cheney’s September 14, 2014 injury described as a right shoulder strain. A Notice of Compensation Payable was then issued on January 14, 2015 which described the injury as a right shoulder strain / sprain.
Ms. Cheney was treating for her work injury with Dr. DeLuca at OIP. Dr. DeLuca diagnosed her with a labrum tear of the Right shoulder. She underwent three surgeries performed by Dr. DeLuca and she developed adhesive capsulitis, she attended physical therapy, received acupuncture and was prescribed a H-Wave stimulator unit. Dr. DeLuca had indicated she should use the H-Wave machine indefinitely. The insurance carrier filed a Utilization Review regarding the reasonableness and necessity of the H-Wave stimulator and supplies as prescribed by Dr. DeLuca. On February 2, 2016, the Utilization Reviewer, Dr. Mitchell Antin, found that the H-wave unit and supplies were not necessary nor reasonable for her work injury. Dr. Antin reported that there had been insufficient clinical research to demonstrate the effectiveness of the unit. We filed a Petition for Review of the Utilization Review Determination.
Ms. Cheney testified that the she used the H-Wave daily and that it took some of her pain away and that it helped her to be able to do more activities, it helped her range of motion and she was able to stop taking prescription medications because of the relief she had using the unit. The Judge granted our Review of UR Petition in which she found that the H-Wave unit and supplies were reasonable necessary for Ms. Cheney’s work injury. We had offered into evidence medical studies in support of Ms. Cheney’s use of an H-Wave machine and the Judge found that it was unclear if the UR Reviewer, Dr. Antin, even reviewed any clinical research regarding the machine. The Judge reported in her Decision that she believed that more research needs done in order to determine the scientific efficacy of H-Wave treatment, but it was not her role to make a determination as to whether treatment is scientifically supported. The Judge ordered that the insurance carrier was responsible for payment of the H-Wave machine and supplies.
