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I&F Case Study: The IME and Issues of Necessary Medical Treatment

Although reasonable people might disagree as to the benefits of chiropractic care in the WC arena, there is no arguing the fact that a long term course of care with a chiropractor for a back injury can lead to a difficult claim.  It’s also no secret that the Commission can express a preference for the opinions of treaters as opposed to IMEs on questions of necessary medical care.   That said, a recent case litigated by Jack Shanahan of I&F shows us the importance of not giving up on a good IME opinion in this situation.

In this case the Commission upheld a favorable decision by the Arbitrator on a disputed back injury claim in which petitioner underwent years of dubious chiropractic care, and ultimately was recommended for a lumbar fusion surgery by a doctor affiliated with the chiropractic clinic.  The Arbitrator adopted our IME opinion and denied our liability for any medical bills following the August 29, 2008 IME.  In addition, the Arbitrator adopted our Utilization Review report and denied most of the chiropractic care, even some that preceded August 29, 2008.

By virtue of the Arbitrator’s finding on causal connection, the Arbitrator denied petitioner’s request for over one year in additional TTD benefits, close to $40,000.00 in submitted medical bills, and severely reduced the demanded 25% man as a whole PPD award.  In the end, respondent owed petitioner no benefits whatsoever for TTD after prior credits were counted, and the Arbitrator found that a prior PPD advance was sufficient for petitioner’s PPD award.  The Commission affirmed the decision following Petitioner’s review.

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