Opinion No. 22
from the Industrial Commission.
Commission order denying benefits, vacated and remanded for
& Porter, PA, Idaho Falls, for appellant.
A. Adams argued.
& Bailey, LLP, Boise, for respondents.
Scott Wigle argued.
BURDICK, Chief Justice.
appeal arises from an Industrial Commission (the Commission)
order denying medical care benefits to Channel Rish. The
Commission held that Idaho's Worker's Compensation
Act did not require Respondents to pay for the medical care
Rish received after she achieved maximum medical improvement
because that medical care was deemed unreasonable. On appeal,
Rish contends the Commission's order is not supported by
substantial and competent evidence, and moreover, the
Commission misapplied the governing legal standard when
determining whether the medical care was reasonable. We
vacate and remand.
FACTUAL AND PROCEDURAL BACKGROUND
worked as a cashier at Home Depot. While working on October
30, 2005, Rish slipped on a floor mat and injured her right
knee. The injury ultimately required Rish to undergo three
knee surgeries, which Dr. Casey Huntsman performed in 2005,
2006, and 2007.
August 9, 2007,  roughly three
months after Rish's third surgery, Dr. Huntsman concluded
Rish had achieved maximum medical improvement (MMI). Dr.
Huntsman, however, further noted that Rish "definitely
needs . . . continued pain management" with Dr. Holly
end, Rish visited Dr. Zoe for pain management treatment. But
because that treatment did not improve Rish's knee pain,
Respondents grew skeptical as to Rish's continued medical
care and surmised that Rish was merely seeing Dr. Zoe to get
pain medication. Therefore, in January 2008, Respondents
arranged for Rish to receive an independent medical
examination (IME) with Drs. Robert Friedman and Christian
Gussner. Those doctors concluded Rish had not yet achieved
MMI and recommended Rish attend a chronic pain management
program while being weaned off pain medication. Rish never
attended that chronic pain management program and instead
continued seeing Dr. Zoe for treatment throughout 2008.
such, Respondents remained skeptical as to Rish's
continued medical care with Dr. Zoe. Thus, in January 2009,
Respondents arranged for Rish to receive another IME, this
time with Drs. Christian Gussner and Michael McClay, a
psychologist. Dr. Gussner "was unable to detect any
ongoing problem with [Rish's] right knee" and
recommended she stop taking pain medication. Dr. McClay
concluded Rish had a "long history of personal problems
and medical problems" and ...