GQ Corner

Q. The employee was sitting cross-legged in her chair without her shoes on when she went to get up and placed her left foot on the floor. Then when she placed her right foot on the floor she heard a loud crack. The employee has been diagnosed with a non-displaced fracture of the 5^th metatarsal bone in her right foot. The employer states she was only getting up & is not work related. Is this mechanism of injury compensable?

A. I would agree that this is probably compensable, assuming she was 1) on premises and assuming she was 2) sitting like this while getting paid. Yes, if the stepping onto ground caused her fracture, then the instrumentality of the ER (the floor) in contact with her foot caused the injury.

Q. Can we use a peer review to deny the need for further treatment if it states that further treatment is not medically necessary per the ODG?

A. Under no circumstance may you deny future medical treatment except in the preauthorization context. Merely suggesting that you are going to do so is an administrative violation that the DWC takes very seriously.