Background
William Dziatkowicz sustained a compensable lower back injury on March 9, 2023, while lifting a 90-pound HVAC pump at work. Imaging revealed multiple disc herniations and stenosis. He underwent back surgery in April 2023, including a far lateral microdiscectomy and decompression at L3-L4. The claim administrator authorized extensive post-operative treatment, including over 100 post-surgical treatments and physical therapy.
In May 2024, Dr. Scott Rainey evaluated Mr. Dziatkowicz and opined he had reached maximum medical improvement (MMI), though he would continue to have symptoms and should continue pain management. Based on Dr. Rainey’s MMI determination, the claim administrator closed the claim for temporary total disability (TTD) benefits in December 2024 and denied authorization for additional physical therapy and work hardening.
Mr. Dziatkowicz protested both orders. Subsequent medical evidence from treating providers showed documented improvement: Dr. Shetty noted discontinuation of cane use and steady progress; a March 2025 physical therapy re-evaluation indicated Mr. Dziatkowicz had a high probability of returning to work without modifications with six more weeks of conditioning. The Workers’ Compensation Board of Review affirmed the claim administrator’s decision on July 16, 2025.
The Court’s Holding
The Intermediate Court of Appeals vacated and remanded the Board’s decision, finding the Board committed clear error by failing to adequately consider and address all evidence in the record. The court identified three critical omissions: the Board did not discuss Dr. Shetty’s treatment notes documenting Mr. Dziatkowicz’s actual improvement and discontinuation of cane use; the Board did not address the physical therapy records dated March 19, 2025, showing excellent rehabilitation progress and high probability of returning to work without modifications; and the Board failed to provide adequate analysis of why the claimant was no longer entitled to additional treatment.
The court further found the Board failed to address Mr. Dziatkowicz’s argument that the employer had already approved treatment beyond Rule 20 (treatment protocol) guidelines when it denied his request for additional therapy. The Board’s conclusory statement that “the evidence does not establish that this is an extraordinary case” was insufficient without substantive analysis. The court emphasized that the Supreme Court of Appeals has stressed the importance of the Board performing adequate analysis and fully explaining its findings in each claim.
The court also noted that while Dr. Rainey found Mr. Dziatkowicz capable of performing modified duty work, there was no indication that modified duty positions were available or had been offered by the employer.
Key Takeaways
- A finding of MMI does not automatically preclude authorization for additional treatment if medical evidence documents continuing improvement and functional gains after the MMI determination.
- Administrative review boards must provide substantive analysis addressing all evidence presented, not merely conclusory statements, particularly when claimants submit post-determination evidence showing progress.
- Treatment authorized beyond statutory guidelines may establish an extraordinary circumstance requiring individual analysis rather than automatic application of protocol limitations.
- Employers offering modified duty work must actually make such positions available; theoretical capacity for modified work does not eliminate TTD if no suitable modified positions exist.
Why It Matters
This decision clarifies that workers’ compensation boards cannot rely on MMI determinations to categorically deny ongoing rehabilitative treatment when subsequent medical evidence demonstrates the claimant continues to improve functionally. The ruling reinforces heightened procedural requirements for administrative decision-making, requiring substantive engagement with the full record rather than perfunctory analysis. For claimants, this case establishes that documented post-MMI improvement—particularly objective functional gains like increased lifting capacity or reduced mobility aids—can support continued authorization for therapy and potentially continued TTD benefits.
The decision also highlights the importance of evidentiary development in workers’ compensation appeals. The court’s remand with instructions to “reevaluate the medical evidence submitted by the parties” suggests the outcome on remand may differ substantially from the Board’s initial decision once proper analysis is applied to the full medical record.