On June 14, 2011, the Missouri Court of Appeals, Western District, issued an opinion addressing the applicability of the prevailing factor standard in Missouri workers’ compensation cases. The claimant/employee sought workers’ compensation benefits after suffering a torn lateral meniscus during an on the job accident. Because the claimant had a degenerative arthritic condition, arthroscopy was not an option. Instead, a total knee replacement was required.
The employer denied coverage for the total knee replacement, asserting that the torn lateral meniscus was not the prevailing factor in causing the need for the total knee replacement. The Administrative Law Judge agreed, as well as the Labor and Industrial Relations Commission.
The Court of Appeals, however, did not agree, thereby reversing the decision. The Court held that, once it is determined that a compensable injury has occurred, the test for determining if treatment should be covered is whether the treatment is reasonably required to cure and relieve the effects of the injury. In other words, prevailing factor need not be demonstrated when determining if a particular treatment is necessary following a compensable injury. The case is Tillotson v. St. Joseph Medical Center.