Background
David Gilbert, a City of Wheeling firefighter, injured his left wrist while pulling on a stuck valve on April 18, 2024. The claim administrator held the claim compensable for a left wrist sprain. Gilbert continued to report pain, popping, and instability despite working full duty and receiving conservative treatment.
Although a November 2024 MRI was unremarkable, treating physician Dr. Charles Tracy recommended diagnostic arthroscopy based on Gilbert’s history, examination, persistent symptoms, failed conservative care, and suspected ligament injury. The claim administrator denied authorization after Dr. Jerry Magone opined that arthroscopy was inappropriate for what he characterized as a wrist strain. Gilbert protested, and the Board of Review reversed the denial. Gilbert underwent the procedure in May 2025; the post-operative diagnosis was a partial tear of the left ulnocarpal ligament.
The Court’s Holding
The Intermediate Court of Appeals affirmed the Board’s January 28, 2026, order authorizing left wrist arthroscopy. The court held that the Board was not clearly wrong in finding the procedure medically related and reasonably required treatment for Gilbert’s compensable left wrist sprain.
The Board reasonably found Dr. Magone’s opinion unpersuasive because the claim had been held compensable for a sprain, not a strain, and because Dr. Tracy’s request was grounded in Gilbert’s symptoms, examination, failed conservative measures, negative MRI, and suspicion of ligament damage—not the rationale attributed to him by Dr. Magone. Applying deferential review, the court found substantial support for the Board’s decision.
Key Takeaways
- An unremarkable MRI does not necessarily preclude diagnostic arthroscopy when other evidence supports suspected ligament injury.
- Workers’ compensation treatment must be medically related and reasonably necessary for the compensable injury.
- On appeal, the court deferred to the Board’s fact-supported evaluation of competing medical opinions.
Why It Matters
The decision underscores that authorization disputes turn on the complete medical record, not imaging alone. Where a treating physician offers a supported explanation for diagnostic surgery after persistent symptoms and conservative-treatment failure, the Board may approve the procedure despite a contrary record-review opinion.