Let’s take a moment to consider this hypothetical scenario:
John Smith is at work for the Widget Company working on the assembly line. Mr. Smith has been working for about 10 hours when he faints, causing him to fall and hit his head on the ground beneath him. The Widget Company gets Mr. Smith to an emergency room where several tests are run to determine the cause of Mr. Smith’s fainting spell. A review of the diagnostic testing and Mr. Smith’s medical history uncovers that Mr. Smith has a history of fainting due to a personal health condition and he has experienced these fainting spells several times in the background. The Emergency Room physician tells Mr. Smith that the fainting spell was related to his personal health condition and provides him recommendations how to address this issue in the future.
Now, the million-dollar question: Is the diagnostic testing performed on Mr. Smith a covered benefit under South Dakota workers’ compensation law?
Whenever the purpose of the diagnostic test is to determine the cause of a claimant’s symptoms, which symptoms may be related to a compensable accident, the cost of the diagnostic test is compensable, even if it should later be determined that the claimant suffered from both compensable and noncompensable conditions. Mettler v. Sibco, 2001 S.D. 64, ¶ 9, 628 N.W.2d 722, 724.
We get several questions about whether or not diagnostic testing is compensable when the ultimate outcome relates the reason for the event pointing to a personal health condition. However, keep the above case law in mind when evaluating the responsibility for payment of diagnostic testing to determine the medical explanation for an accident or injury.
As always, please call us if you have any questions, we are happy to help.