Appeals court says comp board didn’t properly analyze worker’s claim
- August 20, 2025
- Posted by: Web workers
- Category: Workers Comp
West Virginia’s Intermediate Court of Appeals ruled that the state’s Board of Review failed to properly analyze a worker’s claim for additional treatment and pain management by not considering all evidence.
As documented in Boggs v. Justice Family Group LLC, Donna Boggs worked for Justice Family Group. She slipped and fell while at work in January 2024. Ms. Boggs saw a doctor the day of her fall, complaining of neck pain, left hip pain and low-back pain. An X-ray of the cervical spine showed no acute osseous abnormality. An X-ray of the lumbosacral spine revealed degenerative changes with extensive scoliosis and no evidence of an acute lumbar spine fracture.
Over the next six months, Ms. Boggs saw a second doctor several times. The doctor assessed pain of the left hip joint, neck pain, low-back strain, long-term use of nonsteroid anti-inflammatory drugs, strain of neck muscle, somatic dysfunction of the lumbar region, somatic dysfunction of the pelvic region, chronic low-back pain, obesity and chronic pain syndrome.
Ms. Boggs underwent two MRI scans in 2024, both of which revealed some issues including degenerative changes. She was referred for osteopathic manipulative therapy.
Another doctor evaluated Ms. Boggs, assessing an exacerbation of preexisting neck and back pain. The doctor opined that there was no evidence of any new injury from the January 2024 fall and that no further treatment was necessary.
A claims administrator for Justice Family Group’s insurer issued an order denying authorization for a pain management appointment and osteopathic manipulative therapy. The Board of Review affirmed.
In reversing and remanding the case, West Virginia’s Intermediate Court of Appeals said Friday that the board failed to adequately consider and analyze the evidence in the claim, adopting the findings of the third doctor “without any explanation or determination of the reliability/credibility of the evidence.”
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