The Supreme Court of Appeals of West Virginia reversed a lower court decision on April 15, 2025, reinstating workers’ compensation benefits for an auto technician whose claim for continued temporary total disability (TTD) benefits and authorization for a repeat MRI had been denied. The case, Roger Weese v. Harry Green Chevrolet, Inc., centered on whether the claimant’s compensable “low back” injury had reached maximum medical improvement (MMI) when the claim administrator closed his benefits and refused further diagnostic evaluation.
Roger Weese sustained an injury on January 4, 2021, while working as a technician at Harry Green Chevrolet, Inc. His right hand was caught between a tire and strut during the incident, and he also reported pain in his lower back radiating down his right leg. Initially attempting to work through the discomfort, Weese stopped working by January 12 and sought treatment. A chiropractor referred him for imaging, and subsequent examinations confirmed symptoms consistent with low back pain and sciatica.
On January 26, 2021, Dr. Russell Biundo diagnosed Weese with lumbar radiculopathy and a possible herniated disc. A February 5 MRI confirmed multilevel degenerative changes, including a right paracentral disc extrusion and annular tear at L4-L5. The claim was held compensable on February 1, 2021, for “low back,” and Weese was awarded TTD benefits.
Over the following months, Weese pursued treatment including physical therapy, medication, and emergency care for recurrent back pain, numbness, and weakness. A functional capacity evaluation conducted on October 29, 2021, concluded that while he had shown improvement, he remained unable to safely return to work and required additional therapy.
On November 1, 2021, at the employer’s request, Weese underwent an independent medical examination (IME) by Dr. Joseph Grady. Dr. Grady concluded that Weese had reached MMI for a “lumbar sprain” and recommended closure of the claim and termination of benefits. However, he acknowledged that he did not have records from the recent functional capacity evaluation and misidentified the compensable condition. The claim had been held compensable for “low back,” not specifically “lumbar sprain.” Dr. Grady also noted age-related degenerative findings but offered no work restrictions.
Following this report, the claim administrator issued two orders in January 2022: one closing the claim for TTD benefits and another denying authorization for a repeat MRI requested by Dr. Biundo. The Workers’ Compensation Board of Review affirmed both orders, finding that Weese had reached MMI and that the MRI was not medically necessary because a herniated disc was not a compensable condition. The Intermediate Court of Appeals affirmed the Board’s decision, stating that no medical provider had submitted a Diagnosis Update requesting “herniated disc” as an additional compensable condition.
The Supreme Court reversed. The Court held that the preponderance of the medical evidence established that Weese had not reached MMI when his claim was closed. The justices emphasized that Dr. Grady’s opinion was based on the wrong compensable condition, failed to account for the functional capacity evaluation, and was therefore of limited value. In contrast, Dr. Biundo and his team, including physician assistant Gary P. Barcinas, consistently diagnosed Weese with both a lumbar sprain and a herniated disc, and advised continued treatment and diagnostic imaging.
The Court also rejected the claim administrator’s position that the MRI was unjustified because a herniated disc was not listed as a compensable condition. It found that “low back” is a broad enough designation to encompass a disc injury, especially when a herniated disc was identified as a possible diagnosis prior to the claim’s acceptance. The Court noted that there was no indication Weese had pre-existing back issues, and that both treating physicians and another IME provider, Dr. Christopher Martin, found the MRI findings potentially related to the workplace injury.
Because Weese had not reached MMI and had not been released to return to work, the statutory conditions for terminating TTD benefits under West Virginia Code § 23-4-7a were not met. The Court concluded that Weese was entitled to reinstated benefits and the requested MRI.
The Court remanded the matter to the Board of Review with directions to issue an order consistent with its ruling.
The case was adjudicated entirely under West Virginia’s workers’ compensation statutes and evidentiary standards.
