Should Workers Comp Carrier Pay for Extended Testing

The Question:

Should Workers’ Compensation Carrier be required to pay for extended testing protocol following exposure of hospital employee to patient’s blood?

Here’s What Happened
A health care worker was splattered in the face and eye with blood and saline while flushing a patient’s intravenous (IV) line. The worker sought immediate medical attention, at which point the applicable post-exposure protocol required by OSHA was initiated. The protocol required a series of five office visits including tests for bloodborne pathogens, for a total cost of about $700.00. The carrier paid for the first two visits, and part of the third, but resisted further payment, stating its policy was to pay for an initial test and one follow-up “as a matter of custom and practice and a courtesy to its members.” The carrier took the position that an exposure has the potential to harm but does not constitute an injury until such time as objective medical findings showed it had produced a harmful change in the human organism.

Here’s How the Court Ruled
In Kentucky Employers Safety Assoc., v. Lexington Diagnostic Center, 2009 Ky. LEXIS 80 (May 21, 2009), the Supreme Court of Kentucky held that being splattered in the face and eye with foreign blood or other potentially infectious material is a traumatic event for the purposes of KRS 342.0011(1), that the presence of blood in the eye constitutes an exposure as defined in 29 CFR 1910.1030(b), which shows a harmful change in the human organism, i.e., the introduction of foreign blood or potentially infectious material into the worker’s body. The court stressed that appropriate medical treatment included not only treatment for the injury’s immediate effects, it also included treatment to help determine if the exposure produced harmful changes not evident immediately or to address such changes. Additionally, what treatment was reasonable and necessary depended on the circumstances, said the court. (workersxzcompxzkit) The court concluded that the ALJ did not err in finding that the worker sustained an injury and that the carrier was liable for reasonable and necessary medical treatment, including both the initial treatment and post-exposure prophylaxis.

See generally Larson’s Workers’ Compensation Law §§ 5.05, 29.03, 42.01, 51.02, 51.06, 55.01, 55.02, 94.03.

Author: Tom Robinson, J.D.
Tom Robinson, J.D. is the primary upkeep writer for Larson’s Workers’ Compensation Law (LexisNexis) and Larson’s Workers’ Compensation, Desk Edition (LexisNexis). He is a contributing writer for California Compensation Cases (LexisNexis) and Benefits Review Board – Longshore Reporter(LexisNexis), and is a contributing author to New York Workers’ Compensation Handbook(LexisNexis). Attorney Robinson is an authority in the area of workers’ compensation and we are happy to have him as a Guest Contributor to Workers’ Comp Kit Blog. Tom can be reached at: compwriter@gmail.com.
http://law.lexisnexis.com/practiceareas/Workers-Compensation

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