Grom: Workers’ Compensation Treatment Can Provide Relief Even When an Injury Cannot Be Cured

Living with a lasting work injury can mean managing pain, medication effects and the tasks that have become harder. Treatment can matter because it helps you function, even when a full recovery is out of reach. California’s medical-treatment standard recognizes relief as a legitimate goal.

In Grom v. Shasta Wood Products, 69 Cal.Comp.Cases 1567 (WCAB Dec. 8, 2004), the Appeals Board affirmed an award of treatment intended to address an effect of medication used for an admitted back injury. The insurer argued that the treatment had to both cure and relieve the injury. The Board explained why reasonably required relief was enough to satisfy that part of the legal standard. The medical evidence supporting the particular treatment still mattered.

The requested care addressed an effect of pain medication

The opinion in Grom describes a July 1999 back injury at work. His care included pain-management treatment and opioid medication. In a March 2004 progress report, his treating chiropractor described severe pain and restricted movement. The report also noted a low testosterone level and that Grom could no longer afford the testosterone treatment he had been paying for himself.

His pain-management physician, Dr. Leonard Soloniuk, recommended testosterone cream to counter the decrease in testosterone associated with opioid therapy. The utilization-review physician denied the request, challenging both the medical support and the causal connection to the work injury.

The pain-management physician responded to the denial, connecting the requested treatment to chronic opioid use and quoting a published medical article. At trial, Grom offered scientific studies and abstracts addressing the connection between daily opioid use and reduced testosterone. His offer of proof also described earlier use of the cream and improved energy and daily functioning.

The insurer’s interpretation would have excluded treatment that only relieved symptoms

The insurer relied on the guideline-rebuttal provision then in effect, Labor Code section 4604.5(c). It argued that a departure from the guidelines had to be necessary to cure and relieve the worker, and that the cream would not cure his back injury, chronic pain or opioid use.

The Board read that language alongside Labor Code section 4600 and the broader workers’ compensation scheme. Section 4600 used cure or relieve. The Board’s reasoning in Grom treated these formulations consistently: An injured worker could receive medically required relief even when the underlying condition could not be cured.

The Board compared the wording across the workers’ compensation system. California’s Constitution described treatment to “cure and relieve,” while section 4600 used “cure or relieve.” The treatment-guideline provisions then contained both formulations. Reading them together, the Board treated relief as a compensable purpose without requiring each measure to cure a lasting injury.

That distinction has a practical purpose. A worker with a lasting injury may need continuing measures to reduce symptoms and maintain function. If every treatment had to eliminate the injury itself, relief for those lasting effects would fall outside the system.

The medical connection and supporting evidence were separate questions

The treatment request linked the cream to medication prescribed for the back injury and the resulting reduction in testosterone. The physician’s reports and supporting materials addressed why that treatment was reasonably necessary.

The judge found the medical and scientific material sufficient to support the recommendation and rebut the treatment-guideline presumption then applicable. The Board affirmed in Grom, adopting the judge’s report on the remaining arguments.

The result therefore rested on more than a general request to feel better. The record identified a particular treatment, an asserted consequence of industrial-injury care and medical material supporting the recommendation.

Today’s treatment-review process must also be followed

The core standard remains in current Labor Code section 4600: The employer must provide treatment reasonably required to cure or relieve the effects of the work injury. The same statute ties reasonable treatment to California’s adopted treatment guidelines.

The review procedure has changed since this 2004 decision. For a covered utilization-review denial or modification based on medical necessity, section 4610.5 provides Independent Medical Review. A worker seeking treatment today needs to address the current medical standard and the correct review process, rather than simply reproduce the trial procedure used in Grom.

Today’s treatment choice requires an assessment of the worker’s present condition, treatment risks, alternatives and applicable medical standards by the treating physician.

What to ask when useful relief is the goal

Ask the requesting physician to explain what the proposed treatment is expected to improve and how that improvement relates to the work injury or its treatment. If the concern is a medication effect, the relevant records should identify the medication history, the suspected effect and the medical basis for addressing it.

Then compare that explanation with the actual denial. An objection that a treatment will not cure a permanent injury raises a different question from an objection that the treatment lacks medical support. In Grom, the Board addressed the first question and affirmed the judge’s evidence-based resolution of the second.

Our treatment-denial checklist explains the separate steps for reviewing the notice, medical records and IMR form. For help with a disputed treatment request, see our California workers’ compensation practice.