Opinion ID: 4565860
Heading Depth: 2
Heading Rank: 3

Heading: The Miller Test Is the Applicable Test

Text: {¶ 13} Medical-service-reimbursement claims that are contested between an injured worker and a self-insuring employer are adjudicated by the commission. R.C. 4123.511(B)(3) and (C). In making those determinations, the commission applies the standard set forth in Miller, 71 Ohio St.3d at 232, 643 N.E.2d 113.
{¶ 14} In Miller, the injured worker suffered from obesity prior to injuring her back at work. Id. at 229, 231. Four years after her injury, she requested the commission’s approval to enroll in a supervised weight-loss program. Id. The commission denied the request because obesity was not an allowed condition in the claim, and the Tenth District upheld that decision. Id. at 230-231. On appeal, this court first noted that other states had found treatments for obesity to be compensable in workers’ compensation claims when the treatments were curative and not merely palliative, i.e., the treatment would actually improve the allowed condition, not merely relieve pain associated with it. Id. at 232. We then explained that preexisting obesity itself could never be an allowed condition, because it is not limited to a particular body part and lacks the requisite causal relationship to a work injury. Id. at 233. But, we held that although the claimant’s obesity was (a) 6 January Term, 2020 preexisting and (b) not an allowed condition, a specialized weight-loss program to treat the obesity could be a reimbursable medical expense and that “[t]he requisite causal relationship question    is to be addressed by the three-step test” set forth above. Id. at 233-234. {¶ 15} The commission subsequently incorporated the three Miller criteria into its regulation governing approval of medical-service-reimbursement requests. Ohio Adm.Code 4123-6-16.2(B). However, the Tenth District has continued to refer to the standard as “the Miller test.” See, e.g., State ex rel. Cleveland Clinic Found. v. Indus. Comm., 10th Dist. Franklin No. 10AP-329, 2011-Ohio-2269, ¶ 2728; State ex rel. Cassens Transport Co. v. Indus. Comm., 10th Dist. Franklin No. 11AP-680, 2012-Ohio-4829, ¶ 8. {¶ 16} Omni Manor argues that that in Griffith, 87 Ohio St.3d 154, 718 N.E.2d 423, we essentially altered or augmented the Miller test for cases involving contributing nonallowed conditions, requiring claimants in those cases to show that the requested medical treatment would be required even in the absence of the nonallowed condition, and that we reiterated this new test in Jackson Tube, 99 Ohio St.3d 1, 2003-Ohio-2259, 788 N.E.2d 625. Omni Manor misreads our opinions in those cases.
{¶ 17} Griffith, 87 Ohio St.3d 154, 718 N.E.2d 423, was not a medicalservice-reimbursement case and did not involve an application of the Miller test. Instead, Griffith involved a request for temporary-total-disability (“TTD”) compensation for a period of disability caused by the injured worker’s need to recover from knee surgery. Id. at 154-155. The self-insured employer had both approved and paid for the surgery based on the treating physician’s certification that the procedure was to treat the injured worker’s allowed conditions—contusion and meniscus tear. Id. at 155. However, the physician’s reports on the day of surgery stated that degenerative arthritis, a nonallowed condition, was the reason 7 SUPREME COURT OF OHIO for the procedure. Id. This led the commission to deny the request for TTD compensation: because the surgery was not for an allowed condition, the period of disability caused by the surgery did not result from the industrial injury. Id. {¶ 18} Before this court, the injured worker argued that the employer had implicitly certified her arthritis as an allowed condition by approving the knee surgery with the knowledge that she also suffered from nonallowed arthritis in her knee. Id. at 156. Our response to that argument forms the basis of Omni Manor’s argument in this case. {¶ 19} In rejecting the notion that the employer had implicitly allowed the arthritic condition by approving the knee surgery, we first took note of the treating physician’s statement that while early arthritic changes were present in the knee, they “ ‘would really not [have] chang[ed] the fact that she [was] having enough trouble for arthroscopic procedure.’ ” (Brackets sic.) Id. Therefore, we said, “The court of appeals reasonably concluded that even with the accompanying nonallowed arthritic condition, this statement suggested that the allowed knee condition, by itself, necessitated the planned surgery.” (Emphasis added.) Id. We then stated: And since the existence of a contributing nonallowed condition is not a legitimate reason for refusing to pay for medical treatment independently required for an allowed condition, State ex rel. Waddle v. Indus. Comm. (1993), 67 Ohio St.3d 452, 457, 619 N.E.2d 1018, 1021, approval of the surgery in reliance on the letter would not imply acceptance of a new condition. Id. at 156-157. We concluded, “The court of appeals correctly found that some evidence supported the commission’s denial of TTD.” Id. at 157. 8 January Term, 2020 {¶ 20} Because Griffith was a TTD-compensation case, not a medicalservice-reimbursement case, the issue whether the commission had abused its discretion by authorizing medical services was not before us. We did not mention, let alone apply, the Miller test. See Griffith, 87 Ohio St.3d at 154-157, 718 N.E.2d 423. The statement we quoted above merely explained that the employer did not face a choice between rejecting the surgery or implicitly allowing a nonallowed condition—i.e., the nonallowed condition was irrelevant as long as the surgery was properly approved for the allowed condition. Our citation to Waddle demonstrates this intent: Waddle was a permanent-total-disability-compensation case that, like Griffith, did not involve an application of the Miller test. Waddle at 455, 457. Indeed, Waddle is often cited for the concept that nonallowed conditions cannot be used to advance or defeat a claim for compensation. See id. {¶ 21} Moreover, the “independently required” standard that Omni Manor argues Griffith created for cases involving contributing nonallowed conditions would be inconsistent with the underlying Miller test. Omni Manor argues that Griffith requires claimants in such cases to show that the requested medical services would be required even if the nonallowed conditions did not exist. But the Miller test does not obligate a claimant to show that the requested medical services are required—only that they are “reasonably related to” and “reasonably necessary for treatment of” an allowed condition. (Emphasis added.) Miller, 71 Ohio St.3d at 232, 643 N.E.2d 113. This inconsistency is not addressed in Griffith, because we intended no such modification of the Miller test. {¶ 22} Given the issue that we were deciding in Griffith, our statement must be read as one couched in the context of the existing medical-servicereimbursement framework rather than as a significant yet undiscussed alteration of that framework. Accordingly, the phrase “independently required for an allowed condition,” id. at 156, may be stated another way as “satisfying the Miller test as to the allowed condition.” 9 SUPREME COURT OF OHIO
{¶ 23} Our holding in Jackson Tube, 99 Ohio St.3d 1, 2003-Ohio-2259, 788 N.E.2d 625, which was a medical-service-reimbursement case, underscores this conclusion. In that case, the injured worker’s allowed condition was a rotator-cuff tear, but the treating physician believed that there was additional—but unknown— pathology in the shoulder related to the industrial injury. Id. at ¶ 1-8. The doctor opined that the only way to discover what, if any, additional shoulder problems existed was to perform an arthroscopic surgery, during which he would repair the rotator-cuff tear and use a camera to diagnose any additional conditions. Id. The commission authorized the surgery. Id. at ¶ 13. The employer objected to paying for a surgery to diagnose nonallowed conditions. Id. at ¶ 14-17, 22. The Tenth District found that the Miller test was satisfied and that the commission had not abused its discretion. Id. at ¶ 19. {¶ 24} In affirming the Tenth District’s decision, we distinguished Griffith, 87 Ohio St.3d 154, 718 N.E.2d 423, as “deal[ing] primarily with nonallowed conditions and TTC [temporary-total-disability compensation], not medical treatment.” Id. at ¶ 26. Moreover, we pointed out that Griffith actually hurt the employer’s case, because Griffith noted that “ ‘the existence of a contributing nonallowed condition is not a legitimate reason for refusing to pay for medical treatment independently required for an allowed condition,” id., quoting Griffith at 156, and that the injured worker’s doctor had “always listed the allowed condition of torn rotator cuff as requiring surgery, despite whatever other potential conditions were contemplated,” id. We then concluded that “the commission did not abuse its discretion in applying Miller[, 71 Ohio St.3d 229, 643 N.E.2d 113,] and authorizing surgery.” Id. Neither Griffith nor Jackson Tube altered the Miller test in cases involving contributing nonallowed conditions. 10 January Term, 2020