Opinion ID: 2280019
Heading Depth: 1
Heading Rank: 2

Heading: future medical benefits.

Text: The employer takes issue with the Board's conclusion that the evidence compelled an award of future medical benefits under KRS 342.020(1) as construed in FEI Installation, Inc. v. Williams . [11] Pointing to what it perceives to be critical distinctions between the present case and Williams, the employer relies on Mullins v. Mike Catron Construction/Catron Interior Systems, Inc. [12] to argue that future medical benefits are permitted but not required when a work-related injury produces a 0% permanent impairment rating. The employer maintains that the Board should not have disturbed the ALJ's decision to deny future medical benefits because substantial medical evidence supported it. The employer also maintains that the Court of Appeals erred by failing to address whether the Board substituted its judgment for the ALJ's, thereby exceeding the scope of its review. We disagree. KRS 342.020(1) entitles a worker to reasonable and necessary medical treatment at the time of the injury and thereafter during disability, without regard to the duration of income benefits. FEI Installation, Inc. v. Williams concerned whether KRS 342.020(1) entitles a worker who reaches maximum medical improvement with no permanent impairment rating to future medical benefits. The court determined that an injured worker is entitled to future medical benefits for so long as the injury causes impairment as defined on page 2 of the American Medical Association's Guides to the Evaluation of Permanent Impairment (Guides), Fifth Edition. Impairment, as so defined, means a loss, loss of use, or derangement of any body part, organ system, or organ function. The Williams court explained that the presence of impairment demonstrates a harmful change in the human organism and disability, regardless of whether the impairment and resulting disability are severe enough to warrant a permanent impairment rating or permanent income benefits. [13] The Williams court acknowledged, however, that an injury may be temporary and warrant only temporary medical benefits. [14] Thus, in Mullins v. Catron Construction/Catron Interior Systems, Inc. [15] the court reaffirmed an ALJ's decision to deny future medical benefits to a worker who suffered a temporary exacerbation of his pre-existing condition and failed to show the need for medical treatment after the date he reached MMI. Mullins governs a narrow class of cases to which the present case does not belong. KRS 342.020(1) entitled the claimant to be awarded future medical benefits. He did not sustain a temporary exacerbation of a pre-existing condition, such as occurred in Mullins, [16] but a SLAP tear that required surgery and the permanent implantation of hardware in his shoulder. Thus, evidence that he required no medical treatment as of the date he reached MMI or the date that his claim was heard was an improper basis to deny future medical benefits. As in Williams, KRS 342.020(1) entitles the claimant to reasonable and necessary medical expenses during disability, despite a finding that the injury warranted no permanent impairment rating. Likewise, KRS 342.020(1) and KRS 342.125(3) entitle his employer to reopen in order to dispute the compensability of future treatment that is unreasonable, unnecessary, or unrelated to the injury. [17] KRS 342.310(1) permits either party to be sanctioned for prosecuting or defending such a dispute unreasonably.