Wade Protus Phillips v. Loudoun County, Virginia
1963164
| Va. Ct. App. | Aug 8, 2017Background
- Claimant (deputy sheriff) injured his right arm/wrist in 2006 and was awarded lifetime medical benefits; symptoms persisted despite multiple treatments.
- Treating surgeon Dr. Paul Mecherikunnel excised a neuroma in 2008; claimant later developed recurrent pain, weakness, and sensory symptoms.
- In mid-2013 claimant received a spinal cord stimulator with temporary relief; by 2014 symptoms worsened and Mecherikunnel recommended pain-management adjustments and possible psychiatric evaluation.
- About a week after that visit claimant consulted Dr. Ivica Ducic (unauthorized), who performed peripheral nerve surgery one month later without reviewing records, ordering diagnostics, or sending excised tissue to pathology.
- Claimant experienced only short-lived improvement, continued to report pain and work-related flare-ups, and filed for approval/reimbursement of the unauthorized surgery.
- The Virginia Workers’ Compensation Commission (with one dissent) denied compensation for the unauthorized surgery under the "other good reasons" exception; claimant appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether "other good reasons" under Code § 65.2-603(C) excuse unauthorized surgery | Phillips: Dr. Ducic’s surgery addressed an overlooked neuroma and produced significant improvement, so employer should reimburse | Loudoun County: Claimant failed to follow treating physician’s recommendations; authorized care was not shown inadequate; Ducic’s surgery was not reasonable/necessary | Held: No — claimant failed the Whitlock factors; unauthorized treatment not compensable |
| Adequacy of employer-provided treatment | Phillips: Lack of improvement under Mecherikunnel shows inadequacy; improvement after Ducic proves prior care was insufficient | Employer: Claimant did not pursue Mecherikunnel’s suggested medication/stimulator adjustments and sought unauthorized surgery too quickly | Held: Employer treatment not shown inadequate because claimant did not follow recommended course |
| Whether unauthorized surgery was medically reasonable and necessary | Phillips: Post-op pain reduction and decreased medication need show surgery was reasonable/necessary | Employer: Treating physician Mecherikunnel credibly opined surgery was unnecessary; Ducic failed to review records, order tests, or send pathology; claimant’s symptoms may be psychogenic | Held: Not reasonable/necessary — Commission credited treating physician and denied reimbursement |
| Standard of review and weight of treating-physician opinion | Phillips: contends record shows objective improvement supporting reversal | Employer: Commission entitled to weigh medical evidence and credit treating physician | Held: Appellate court defers to Commission’s factual credibility findings and gives great weight to treating physician; affirms denial |
Key Cases Cited
- Shenandoah Prods., Inc. v. Whitlock, 15 Va. App. 207, 421 S.E.2d 483 (Va. Ct. App. 1986) (establishes tripartite test for "other good reasons")
- H.J. Holz & Son v. Dumas-Thayer, 37 Va. App. 645, 561 S.E.2d 6 (Va. Ct. App. 2002) (reimbursement for unauthorized treatment is a rare exception)
- Boys & Girls Club of Va. v. Marshall, 37 Va. App. 83, 554 S.E.2d 104 (Va. Ct. App. 2001) (Commission’s factual findings supported by credible evidence are binding)
- Staton v. Bros. Signal Co., 66 Va. App. 185, 783 S.E.2d 539 (Va. Ct. App. 2016) (appellate view of facts in favor of prevailing party below)
- Dumas-Thayer (reaffirming standards for assessing unauthorized treatment), 37 Va. App. 645, 561 S.E.2d 6 (Va. Ct. App. 2002) (treating-physician opinion entitled to great weight)