Continuing Medical Maintenance Under the Administrative Workers' Compensation Act (AWCA)

What benefits are included in an order authorizing Continuing Medical Maintenance (CMM)? The term CMM was not formally recognized until 2011, when it was enacted under the then-Workers’ Compensation Code (Code). In the Code, CMM was defined as “medical treatment that is reasonable and necessary to maintain the claimant’s condition resulting from the compensable injury or illness after reaching maximum medical improvement. Continuing medical maintenance shall not include diagnostic tests, surgery, injections, counseling, physical therapy, or pain management devices or equipment, unless specifically authorized by the Workers’ Compensation Court in advance of such treatment.” But do CMM benefits include a spinal cord stimulator, and must the claim be re-opened on a change of condition for the worse in order for the spinal cord stimulator to be approved? A recent appellate decision from Division II of the Court of Civil Appeals (COCA) gives us the answers.

In Prewitt v. Quiktrip Corporation, #120,960, the claimant appealed an order of the Workers’ Compensation Court of Existing Claims which denied his request for a spinal cord stimulator. Per the trial judge’s order, CMM is a “limited and tightly structured exception to the general rule that medical treatment ceases by operation of law when permanent disability begins…(and) only those things first authorized in the medical maintenance order may be brought to the Court’s attention in any manner other than a motion to reopen for a change of condition for the worse.” In other words, since the spinal cord stimulator was not specifically referenced in the CMM Order, the claimant would have to prove a change of condition for the worse to receive authorization for that medical device.

The COCA overturned the Court of Existing Claims order, ruling that CMM, once properly established either by recommendation of the treating physician or an independent medical examiner, “may be reviewed by the Court at any time,” and that the lower Court had “erred in holding Claimant was required to file a motion to reopen and demonstrate a change of condition for the worse.” The matter was remanded back to the trial judge to determine whether placement of the spinal cord stimulator is considered reasonable and necessary to maintain the claimant’s condition, as required in the statutory provision which established CMM.

As this appellate ruling affects mainly those claims which are still active under the Court of Existing Claims, it may have a limited impact for claims under the AWCA. Having said that, we strongly recommend that any orders for CMM under the AWCA set out with specificity what benefits are to be included therein. CMM orders should be limited to prescription medications only, and should exclude spinal cord stimulators, which historically have been considered part of active medical treatment.