Martin v. George C. Hall & Sons, Inc.

Insurance Company

Acadia Insurance

Date Decided

October 3, 2018

Panel Members

Timothy Collier

Glen Goodnough

Evelyn Knopf


Medical Expenses


Back Denial of Treatment Medical Payment Medical Necessity Rugan v. Dole

File Size

176 KB


Summary from the Troubh Heisler Attorneys

Mr. Martin injured his low back at work and underwent surgery. He continued to have chronic low back pain, so his treating doctor prescribed narcotic pain medication. His physiatrist, however, had indicated that he must discontinue the narcotics at some point, and Hall's §207 examiner Dr. Kimball had opined that the continuing narcotic medication was "unwarranted." Judge Elwin denied Mr. Martin's claim for continued narcotic medication, and Mr. Martin appealed.

The Appellate Division upheld the denial, citing the Law Court's 1984 decision in Rugan v. Dole, and holding that “[b]oth the risks and the benefits of a disputed medical treatment are relevant to whether they are reasonable and proper” under the WC Act. The panel held that “The ALJ did not err by considering the risks and side effects of Mr. Martin’s disputed treatment to determine whether it was compensable. Such factors are relevant to whether medical treatment is reasonable and necessary within the meaning of §206.”

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