Background
On July 8, 2024, Deron Bryant was struck head-on by a vehicle owned by Donahue Brothers, Inc., while traveling in Huntington, West Virginia. Bryant sustained injuries to his lower back and left knee. The workers’ compensation claim administrator found the claim compensable for lumbar strain and left knee contusion.
In December 2024, Bryant received a bilateral transforaminal epidural steroid injection (TFESI) that provided significant relief (over 80%), improving his pain, mood, ambulation, sleep, and functioning for approximately three months. In January 2025, his treating physician, Dr. Rudy Malayil, requested authorization for another bilateral TFESI to treat lumbar radiculopathy. However, the claim administrator denied the request on August 5, 2025, concluding the treatment was neither medically necessary nor reasonable for the compensable injury. Bryant appealed to the Workers’ Compensation Board of Review, which affirmed the denial on October 9, 2025.
The Court’s Holding
The Intermediate Court of Appeals affirmed the Board’s denial. The court found that while Dr. Malayil and an independent medical evaluator, Dr. Soulsby, both recommended the TFESI, the treatment was requested specifically for lumbar radiculopathy—a condition not listed as compensable in Bryant’s claim. The only compensable lumbar condition was the original lumbar strain diagnosis.
Under West Virginia Code § 23-4-2, workers’ compensation must provide medically related and reasonably necessary treatment for the compensable injury. The Board determined that Dr. Malayil’s recommendation targeted a non-compensable secondary diagnosis, and therefore Dr. Soulsby’s initial support for the injection was not credible as applied to the compensable lumbar strain. The court applied the deferential “clearly wrong” standard of review and found substantial evidence supported the Board’s decision.
The court noted that Bryant was not precluded from seeking to add secondary conditions—such as lumbar radiculopathy—to his compensable claim. If such conditions were formally added, he could then request authorization for treatment targeting those diagnoses.
Key Takeaways
- Workers’ compensation authorizes treatment only for medically necessary care directly related to compensable conditions; secondary diagnoses must be formally added to the claim to support treatment authorization.
- When a treating physician requests treatment for a non-compensable diagnosis, the authorization may be denied even if the treatment is medically reasonable and recommended by multiple physicians.
- Reaching maximum medical improvement does not automatically preclude pain-management injections, but the treatment must still be medically related and reasonably required for a compensable injury.
- Appellate courts apply deferential review to workers’ compensation board decisions, presuming validity when supported by substantial evidence.
Why It Matters
This decision clarifies the boundaries of workers’ compensation coverage in West Virginia. Employers and insurers may successfully deny medical treatment if the claimant’s treating physician frames the treatment as addressing a non-compensable secondary diagnosis, even if that same treatment might be appropriate for the compensable primary injury. For claimants, the decision underscores the importance of ensuring that all relevant diagnoses are included in the compensable claim scope and that treatment requests clearly link to compensable conditions.
The ruling reflects West Virginia’s principle that workers’ compensation benefits are narrowly tailored to the specific compensable injury and conditions directly flowing from it. Claimants seeking treatment for secondary diagnoses must take the procedural step of petitioning to add those conditions to the claim rather than relying on treating physicians to authorize ancillary treatment based on non-compensable diagnoses.