The West Virginia Supreme Court of Appeals issued a memorandum decision on Jan. 21 in a workers' compensation case involving a city employee's quest for coverage of shoulder replacement surgery following a workplace injury.
Frank Mayer, a City of Clarksburg employee, petitioned the state's highest court after the Intermediate Court of Appeals affirmed a lower court decision denying authorization for a right reverse total shoulder arthroplasty. The case, *Mayer v. City of Clarksburg*, centers on whether the requested surgery is medically necessary and reasonably required treatment for Mayer's compensable workplace injury.
The dispute stems from a workplace fall Mayer sustained on May 24, 2023, while employed by the City of Clarksburg. Following the incident, Mayer sought authorization for shoulder replacement surgery, but faced denials at multiple levels of the workers' compensation system. The Workers' Compensation Board of Review affirmed an April 23, 2024, claim administrator's order denying the surgical authorization in an Oct. 30, 2024, decision. The Intermediate Court of Appeals subsequently upheld that determination in a June 27, 2025, memorandum decision.
Mayer argues that the lower courts erred in finding that the requested shoulder surgery was not medically related to his compensable injury and not reasonably required medical treatment. According to the petition, Mayer's physician, Joshua Sykes, M.D., determined that Mayer developed worsened symptoms in his right shoulder as a direct result of his workplace injury. Dr. Sykes recommended that a reverse total arthroplasty would provide Mayer the best opportunity to regain full function of his right shoulder, which he previously enjoyed before the workplace incident.
Central to Mayer's argument is the assertion that his fall caused new discrete injuries not previously documented in his medical history. The claimant contends that his current symptoms and functional limitations began immediately following the May 24, 2023, workplace incident, suggesting a natural inference of causation under established West Virginia precedent.
Mayer's legal team cited *Moore v. ICG Tygart Valley, LLC*, a 2022 West Virginia Supreme Court decision that addressed causation standards in workers' compensation cases. The *Moore* case established principles for determining when workplace incidents cause compensable injuries, particularly regarding the inference of causation when symptoms appear following a workplace accident.
The City of Clarksburg, serving as the employer respondent, filed a timely response to Mayer's petition, though the specific details of the city's arguments were not fully outlined in the available court documents. The employer's position likely challenges the medical necessity of the proposed surgery and the causal connection between the workplace fall and Mayer's current shoulder condition requiring surgical intervention.
This case highlights ongoing tensions in West Virginia's workers' compensation system regarding medical treatment authorization, particularly for expensive surgical procedures. Workers' compensation disputes over medical necessity determinations have become increasingly common as medical costs rise and employers seek to limit their liability for workplace injuries.
The legal question before the Supreme Court involves the standard of review applied to medical necessity determinations and the evidence required to establish causation between workplace incidents and subsequent medical conditions. The court must determine whether the Intermediate Court of Appeals properly applied established legal standards when reviewing the Board of Review's decision.
Workers' compensation law in West Virginia requires that medical treatment be both medically necessary and reasonably required for the treatment of a compensable injury. Courts must balance the injured worker's right to necessary medical care against employers' interests in avoiding responsibility for pre-existing conditions or unrelated medical issues.
The timing of Mayer's symptoms relative to his workplace fall appears central to the causation analysis. His argument that symptoms and limitations began immediately following the May 24, 2023, incident supports his claim that the workplace fall caused his current shoulder problems requiring surgical treatment.
The case also involves questions about the weight given to treating physician opinions in workers' compensation proceedings. Dr. Sykes' recommendation for shoulder replacement surgery based on his examination and treatment of Mayer represents the type of medical evidence typically considered in such cases.
The Supreme Court's eventual decision could affect how West Virginia courts evaluate medical necessity determinations in workers' compensation cases, particularly regarding expensive surgical procedures. The ruling may also clarify the causation standards applied when workplace incidents allegedly cause or aggravate pre-existing conditions.
For Mayer, the appeal represents his final opportunity to obtain workers' compensation coverage for the shoulder surgery recommended by his physician. The financial implications are significant, as reverse total shoulder arthroplasty procedures typically cost tens of thousands of dollars.
The case demonstrates the complex medical and legal issues that arise in workers' compensation disputes, where injured workers must navigate multiple levels of administrative and judicial review to obtain coverage for recommended medical treatment. The Supreme Court's review will ultimately determine whether Mayer's workplace fall entitled him to surgical treatment under West Virginia's workers' compensation system.