Opinion ID: 4565860
Heading Depth: 3
Heading Rank: 1

Heading: Application of the Miller Test

Text: {¶ 25} As we have stated, under Miller, the commission properly authorizes medical services if (1) the services are reasonably related to an allowed condition, (2) the services are reasonably necessary for treatment of an allowed condition, and (3) the cost of the services is medically reasonable. Id. at 232. {¶ 26} Omni Manor argues that Dr. Tonnies’s report and C-9 form did not constitute some evidence that the reverse total-shoulder arthroplasty was reasonably related to the allowed condition of right-shoulder rotator-cuff tear. In support of this argument, Omni Manor cites the Tenth District’s decision in Cleveland Clinic Found., 10th Dist. Franklin No. 10AP-329, 2011-Ohio-2269. {¶ 27} In Cleveland Clinic Found., the relevant allowed condition was aggravation of preexisting osteoarthritis in both of the claimant’s knees, resulting from a fall. Id. at ¶ 1, 6. The claimant was therefore required to show that the requested medical service—a total knee arthroplasty—was reasonably related to the aggravation of the preexisting condition by the industrial injury, not merely to the preexisting condition itself. Id. at ¶ 25, 28, 39. But the physician’s report on which the commission had relied did not mention aggravation. Id. at ¶ 11, 29-31. It instead referred only to the claimant’s preexisting, nonallowed degenerative conditions. Id. And the C-9 form included only the injury code for the preexisting condition, not the code for aggravation of that condition. Id. at ¶ 32-33. {¶ 28} Here, by contrast, the relevant allowed condition is rotator-cuff tear, not aggravation of a preexisting degenerative condition. And in sharp contrast to the medical report in Cleveland Clinic Found., Dr. Tonnies’s report directly refers to the allowed condition—the “massive rotator-cuff tear”—and then concludes that a reverse total-shoulder arthroplasty is the best option to treat it. Additionally, the August 2016 C-9 form states that the treating diagnosis is “[right] shoulder RCT” and that the service requested is “[r]everse total shoulder arthroplasty.” This was 11 SUPREME COURT OF OHIO evidence from which the commission could conclude that the reasonably related requirement was satisfied.