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What Are Injured Employee’s Rights to Reimbursement for Medical Care Under Workers’ Comp?

The New Hampshire Supreme Court has clarified that a medical provider’s failure to complete a New Hampshire Workers’ Compensation Medical Form, and timely submit it to the workers’ compensation carrier, does not impact whether the injured employee is entitled to receive reimbursement from the carrier for medical expenses related to her workplace injury.

In the Court’s August 12 decision in Appeal of DeBorgne, the employee suffered a work-related injury resulting in a diagnosis of chronic myofascial pain of the right shoulder and cervical spine. Her doctor ordered massage therapy, but not all of the doctor’s contemporaneous treatment notes referenced massage therapy. The treating doctor wrote a letter, however, stating that weekly massage therapy was reasonable and necessary for the injured employee because it helped to decrease her pain and improved her mobility and circulation.

The employee’s massage therapists failed to complete New Hampshire Workers’ Compensation Medical Forms, nor did the therapists submit bills for reimbursement to the carrier. New Hampshire law requires providers to complete this Form (detailing among other things the employee’s medical status and ability to return to work) as a prerequisite to receiving reimbursement for services rendered. The employee paid her massage therapists personally for their services, then ultimately submitted the bills to the carrier for reimbursement. The carrier denied responsibility for the bills, leading to hearings at the New Hampshire Department of Labor on whether the employee was entitled to reimbursement of the bills she had paid for her massage therapy. Before the first Department hearing, the carrier sent the employee to an Independent Medical Examination (IME), at which a doctor examined her for five (5) minutes before concluding that her massage therapy “was not reasonable, related or medically necessary to her injury.”

The New Hampshire Department of Labor Workers’ Compensation Appeals Board (CAB) found that the employee had not met her burden to prove that her massage therapy treatments were reasonable and causally related to her workplace injury. The CAB found the employee credible and credited the opinion of the employee’s treating doctor over the opinion of the IME doctor. Nonetheless, the CAB determined that the employee failed to satisfy her burden because her massage therapists had failed to complete and submit the Workers’ Compensation Medical Forms.

The New Hampshire Supreme Court reversed the CAB, holding that a provider’s failure to complete the Workers’ Compensation Medical Forms “is irrelevant to the determination of whether the treatment received was reasonable, necessary, and related to the workplace injury.” The Supreme Court held that the CAB committed “legal error” by finding that the employee had not met her burden, given that the CAB found the employee credible and credited the treating doctor’s opinion that the employee’s massage therapy was reasonable and necessary.

If you are an injured New Hampshire employee needing assistance with a workers’ compensation claim, you should contact an experienced workers’ compensation attorney such as Benjamin T. King, Esquire, at Douglas, Leonard & Garvey, P.C. New Hampshire Magazine has recognized Attorney King as one of the best lawyers in New Hampshire for representing injured employees in workers’ compensation claims, continuously since 2017. Attorney King can be reached at 1-800-240-1988 or fill out our online contact form.

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