QUESTION: 

We have a claimant with uncontrolled diabetes. I realize we pay for ttd while he can’t have surgery due to uncontrolled diabetes (waiting since Dec 2013) but we don’t have to pay for treatment of the comorbid and testing for getting it under control do we? That would still go to his group health carrier correct?

ANSWER:

This question has not yet been answered by the Kentucky appellate courts.  However, it has been addressed by the Workers’ Compensation Board in Blue Chips Installation, Inc. v. Denniston, (2/18/05).  Steven Denniston injured his low back at work.  Dr. Shaffer recommended a fusion of L5-S1, but Denniston’s poor dentition – a number of untreated cavities – was “a serious health problem” that would need to be addressed prior to proceeding with the operation. With his dentition corrected he could become a surgical candidate.  The ALJ ruled that Blue Chips was liable for the dental work necessary to allow the physicians to proceed with the fusion.  WCB affirmed.

Having reviewed the statutory plan for provision of medical treatment for work-related injuries in Kentucky, and being informed by the foregoing extraterritorial authority, we conclude that the employer may be held liable for the cost of ancillary treatment of a nonwork-related condition that is reasonably required in order to achieve optimum treatment of the compensable injury. The employer is not liable for treatment of a nonwork-related condition that is totally independent of the compensable injury and for which treatment would have been required notwithstanding the compensable injury.

There is substantial evidence in the record, consisting of the testimony of Dr. Shaffer, to support the ALJ’s conclusion that the dental treatment at issue is reasonably required in order for Denniston to undergo the surgical procedure recommended for the cure and relief of his work-related lumbar injury. There is nothing in the record to suggest that the dental treatment – though perhaps advisable or desirable – would have been required notwithstanding the proposed surgery. It was reasonable for the ALJ to conclude on the facts presented below that Denniston’s dental condition could go untreated indefinitely but for Dr. Shaffer’s refusal to perform surgery in the absence of proper treatment.

Under the rule established in Blue Chips, the question is whether treatment of the claimant’s uncontrolled diabetes was required, as opposed to merely being advisable or desirable.  This is a medical question.  You need to send this question to a medical expert to address.  Is this patient’s diabetes a medical condition that can go on untreated indefinitely, similarly to dental cavities, or medical treatment of his diabetes something that would be “required”, as opposed to advisable or desirable, even if he did not require the surgery for treatment of the effects of the work-related injury?  As soon as you obtain an answer from a medical expert, that would provide you with the answer to your question of whether treatment of the diabetes is a workers’ compensation liability.