Kentucky high court rejects challenge to disability guidelines

The Kentucky Supreme Court rejected a worker’s constitutional challenge to the use of a disability manual in her case and denied compensability for her longstanding pain medication prescription.

As documented in Howell v. Floyd County Board of Education, Judy Howell was working for the Floyd County Board of Education in 1993 when she injured her back. In 1995 she was awarded permanent partial disability benefits and future medical expenses.

She continued treatment for back pain as well as sciatica, polyneuropathy and neurologic complications from diabetes. She had been prescribed hydrocodone since 1993.

In 2022, Floyd County initiated a medical fee dispute to contest the compensability of the hydrocodone. A utilization review for the county found that pursuant to the recently adopted Official Disability Guidelines for Treatment of Workers’ Compensation, hydrocodone was not medically reasonable or necessary. The review doctor said that, per guidelines, hydrocodone is not recommended for long-term use because of the lack of evidence supporting its efficacy in long-term pain relief and its associated risks, including dependency and abuse.

An administrative law judge determined that the hydrocodone prescription was noncompensable. The Workers’ Compensation Board agreed, as did the Court of Appeal.

The Kentucky Supreme Court affirmed, noting that the guidelines used are widely applied in several state workers compensation systems and that the administrative law judge was entitled to weigh the conflicting opinions, one of which said Ms. Howell needed the drug, and that two reports supporting noncompensability constituted substantial evidence to support that determination.

In its ruling Thursday, the court rejected Ms. Howell’s argument that the new state drug guidelines did not apply to her claim because she was injured before it was adopted, as the legislature expressly said the formulary applies to all injuries, not just those that occurred after it was implemented.

WorkCompCentral is a sister publication of Business Insurance. More stories here.