Wannie R. Lusk v. Alpha Natural Resources, Inc.

Summary

The Supreme Court of Appeals of West Virginia affirmed the Board of Review’s denial of authorization for Flexeril, Lortab, and Opana in a workers’ compensation claim. The court held that the claimant had exceeded applicable opioid-treatment guidelines and had not shown that his case warranted treatment beyond those guidelines.

Holdings

1. The denial of authorization for Flexeril, Lortab, and Opana was proper because Lusk’s requested opioid therapy exceeded the treatment guidelines and the record lacked sufficient treatment documentation to support authorization.
2. Lusk failed to demonstrate that his claim was an extraordinary case warranting treatment beyond the opioid-treatment guidelines.
3. The Board of Review’s decision was not in clear violation of a constitutional or statutory provision, was not clearly the result of erroneous conclusions of law, and was not based on a material misstatement or mischaracterization of the evidentiary record.

Questions Presented

1. Whether the Board of Review erred in affirming the denial of authorization for Flexeril, Lortab, and Opana under the opioid-treatment guidelines in West Virginia Code of State Rules § 85-20-53.14.
2. Whether Lusk demonstrated that his claim presented an extraordinary case warranting treatment beyond the applicable opioid-treatment guidelines.
3. Whether the Board of Review’s decision violated a constitutional or statutory provision, resulted from erroneous conclusions of law, or rested on a material misstatement or mischaracterization of the evidentiary record.

Disposition

affirmed