Claimant ET, a resident of Harrisburg, Dauphin County, suffered a work injury to her lower back on June 27, 2003,while employed by Red Lobster. The Claimant filed a Petition for Review of Utilization Review Determination for a prescription for a lift chair with heat and massage and a Sleep Number bed from Select Comfort prescribed by Dr. Michael Lupinacci, M.D., from January 21, 2010 and ongoing.
On August 26, 2005 the Claimant underwent an MRI that revealed a minimal annular bulge at L3-4 with slight bilateral facet hypertrophy, minimal canal stenosis, minimal bilateral stenosis, a small annular bulge at L4-5 with facet hypertrophy and mild annular bulge at L5-S1, left and S1 left nerve root involvement.
The Claimant underwent numerous lower back surgeries, including the first surgery in 2004, followed by a revision surgery within a few weeks, hardware implantation surgery, repair of an epidural fistula, removal of hardware and three surgeries for a spinal cord implant. Atrial spinal cord stimulator went well but the permanent implant caused more pain. After stimulation surgery the Claimant experienced hypersensitivity at the implant site, severe scar tissue which caused increased pain and loss of mobility in her arms and neck. The Claimant had pain in the lower and mid back, upper shoulders, right arm and neck. The Claimanthas taken Neurontin, Oxycodone, Oxycontin, Cymbalta and Ambien for a year, which only provided minimal pain relief, and the Claimant was concerned about the side effects of the pain medication. The Claimant purchased a lift chair with heat and massage at an estate sale for $550.00 on May 22, 2010. The Claimant requested the prescriptions for the lift chair and Sleep Number bed because she was not a surgical candidate. The chair would make it easier for her to get up and down without assistance and the bed would help with her pain because the firmness and softness of the mattress were adjustable to provide pain relief.
The Claimant underwent additional treatment which included percutaneous neuromodulation therapy, anti-inflammatory medication, trigger point and epidural steroid injection, myofascial release,and Botulinum B and Depo-Medrol injections. Dr. Lupinacci testified that physical therapy, epidural injections, facet injections and medications failed. Dr. Lupinacci also testified the trial spinal cord stimulator provided low back and lower back extremity pain relief but that the permanent implant resulted in complications and required revision and removal. These complications resulted in continuing back and leg pain.
The Utilization Review Petition was assigned to Judge Francis Williamson in Harrisburg on or about April 26, 2010. The Judge found the testimony of the Claimant to be credible and that it was supported by the opinions of Dr. Lupinacci and the medical records. The Judge found the medical opinions of Dr. Lupinacci to be credible. The Judge found the testimony of Dr. Adelsheimer to be incredible and unpersuasive. Dr. Lupinacci was the Claimant’s treating physician and better able to comment on the necessity of medical treatment than Dr. Adelsheimer, who merely reviewed the medical records. The Judge found Dr. Lupinacci’s prescriptions for the lift chair and Sleep Number bed were reasonable and necessary.
The Claimant’s petition for Review of a Utilization Review was granted. The Defendant and Liberty Mutual Fire Insurance Company were ordered to reimburse the Claimant for the lift chair in the amount of $550.00 and $3,284.93 for the purchase of a Select Comfort Sleep Number bed, and also ordered to pay attorney fees and litigation costs.
