JCC Denies Mattress Request for Lack of Medical Necessity

In Tenpenny-Atkinson v. Surestart Inc./Liberty Mutual Insurance, Judge Barbara K. Case addressed a claimant's request for authorization of a new mattress after a compensable 1990 accident involving head, neck, back, and left-shoulder injuries. The claimant relied on a prescription from Total Spine & Wellness stating that a more supportive mattress was medically necessary.

The employer/carrier disputed the request, arguing that the mattress was not reasonable or medically necessary for the accepted work injuries. The record showed that the physician associate who wrote the prescription did so after the claimant asked whether a new mattress might help, and he later explained that he did not intend the prescription to be submitted as a workers' compensation request.

The order emphasized that the governing 1990 version of section 440.13 required proof that the requested supply was appropriate to the diagnosis, accepted by the relevant peer group, supported by scientific criteria, and connected to treatment of the compensable injury. A prescription using the words medically necessary was not enough without evidence explaining why the item met those standards.

The JCC found that the testimony did not establish what type of mattress was needed, how it would treat the claimant's work injuries, whether it was accepted orthopedic care, or why it would relieve symptoms where prior mattress changes had not helped. The evidence therefore fell short of competent, substantial proof of medical necessity.

The claim for authorization of a new mattress was denied. Because the requested benefit was denied, the associated claim for employer/carrier-paid attorney's fees and costs was also denied.

Source: Compensation Order