Case Study

Reputable Physicians Key to Defeating Unreasonable Treatment

Petitioner was involved in a compensable motor vehicle accident. He sustained injuries to his left shoulder, as well as his cervical and lumbar spine. After hiring an attorney, Petitioner began treating with doctors whose reputation was questionable. Petitioner underwent surgery for the left shoulder, which was undisputed. He was released to full duty work following physical therapy and work hardening.

 

While treating for the shoulder injury, Petitioner began treatment for his lumbar spine. He had an MRI scan, excessive physical therapy, a discogram and was referred to pain management treatment for injections. After failing the discogram, his pain management physician refused the injections. He suddenly stopped treating for the lumbar spine complaints. The following month, Petitioner began complaining of cervical pain, which followed the same course of treatment as the lumbar spine. After a failed discogram of the cervical spine, Petitioner’s treating doctor prescribe surgery, despite a 2nd opinion referral and pain management physician that did not believe surgery was necessary.

 

Respondent obtained an IME with a reputable physician who addressed the MRI findings, as well as the discogram. After reviewing the MRI scan, the IME doctor opined treatment after the MRI scan was not necessary. The IME doctor placed Petitioner at maximum medical improvement and returned him to full duty work as to the lumbar and cervical spine. After the treating shoulder doctor learned of the IME opinion, he kept Petitioner off of work, despite the lack of any findings or complaints as to the shoulder. Respondent pursued a 2nd IME with a reputable upper extremity physician, who placed Petitioner at maximum medical improvement for the shoulder and found him capable of full duty work.

 

Although Petitioner was placed at maximum medical improvement, he continued treatment with his physician and ultimately underwent a 3 level fusion. As expected, the recovery from surgery went terribly. Petitioner was re-examined by the initial IME physician as to the cervical spine. He opined the surgery was not reasonable or appropriate.

 

The case was brought before the Arbitrator on a 19(b) petition. After hearing, the Arbitrator found the IME opinions to be more credible than the treating doctors and denied approximately $90,000.00 in medical bills, one year of TTD benefits and defeated any claim for permanent total disability benefits. The Commission affirmed the Arbitrator’s decision. While the matter was being appealed to the Circuit Court, a settlement agreement was negotiated for the value of the operated shoulder, as well as sprains of the lumbar and cervical spine.