State News : Alabama

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On March 29, 2019, the Alabama Court of Civil Appeals released its opinion in Ex parte Trusswalk, Inc. wherein it addressed a trial court’s ability to order pain management in the absence of a supporting medical necessity opinion from a doctor.  InTrusswalk, the trial court ordered the employer to send the injured employee to pain management despite the fact that no doctor had recommended it.  In issuing the order, the trial court relied on the fact that, after 5 back surgeries, the employee claimed to have chronic low back pain.  The employer promptly filed a petition for a writ of mandamus. 


In its petition, the employer argued that the trial judge lacked the authority to direct a referral for pain management where the authorized treating physician had not recommended same. In its brief and during oral argument, the employer argued that the trial court lacked the authority to order pain management in the absence of a supporting medical necessity opinion from any doctor.


In its opinion, the Court of Appeals cited to the Alabama Administrative Code for both the Board of Medical Examiners and the Department of Labor for the proposition that pain management is a specialty that necessitates a supporting opinion from a medical expert. Since no doctor had offered such an opinion, the Court granted the petition and directed the trial court to vacate its order.


My Two Cents


It is well settled in Alabama that a trial court cannot compel medical treatment when the issue of compensability remains in dispute. So as not to lose control of treatment, employers will sometimes agree to direct medical care while, at the same time, deny the claim.  In Trusswalk, the employer denied all the material allegations of the Complaint in its Answer and, therefore, the issue of compensability remained in dispute.  This was not raised in the employer’s petition and so it was not addressed by the Court of Appeals.   


Two More Cents


Following the hearing on the plaintiff’s motion to compel pain management, the trial court issued an order that included findings of fact and conclusions of law. Interestingly, one of the findings of fact was that the employee suffered a work-related back injury.  The trial court also held that the employee’s chronic pain condition arose out of his work related accident and injury.  Such findings should have only been made following a trial on the merits.  If the judge elected to treat the hearing on the employee’s motion as a trial, then the employer’s right to 60 days’ notice was violated.  If the hearing was not treated as a trial, then the issues of compensability and chronic pain should remain at issue.  Unless the employer can get another Marshall County judge to handle the trial, the proverbial cards on these important issues have already been laid down.

About the Author

This blog submission was prepared by Mike Fish, an attorney with Fish Nelson & Holden, LLC, a law firm dedicated to representing self-insured employers, insurance carriers, and third party administrators in all matters related to workers’ compensation. Fish Nelson & Holden is a member of the National Workers’ Compensation Defense Network. If you have any questions about this submission or Alabama workers’ compensation in general, please contact Fish by e-mailing him at or by calling him directly at 205-332-1448.