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Nurse’s Demand for Surgery Under Section 8(a) Denied

Congratulations to Inman and Fitzgibbons second year associate Steve Miller for successfully relying on an IME opinion at arbitration.  In this case, the claimant, a 50 year old CNA, alleged that she tripped and fell from a standing position onto her left knee after “side-stepping” in a patient’s room.  However, ER records prepared on the date of accident recorded a history of her falling from a “squatting” position and treating records from a day after the accident also contained a squatting history.  At trial, the claimant testified that she was unable to squat due to a prior total knee replacement on her other knee. Her treating physician opined that she sustained a left knee meniscal tear as a result of the accident and recommended an arthroscopy with possible meniscectomy and chondroplasty.  The respondent’s examining physician opined that the claimant suffered merely a contusion to the patella, that the meniscal tear was a pre-existing condition neither caused nor aggravated by the accident, and that falling forward from a squatting position was not a mechanism of injury that could produce a tear of the meniscus.

The claimant filed a request for hearing under Sections 19(b) and 8(a) seeking a finding that her left knee meniscal tear was causally related to the accident, and requested an award ordering the respondent to authorize the recommended arthroscopy.  The arbitrator ruled in favor of the respondent, taking careful note of the inconsistencies in the histories in the medical records and the petitioner’s trial testimony.  Ultimately, the Arbitrator found the petitioner to lack credibility.  The Arbitrator also took note of the fact that while the treating physician testified that it was important to obtain an accurate and complete history from a patient as a factor in determining causation, he did not know any specifics about the alleged fall, except for the fact that she “fell on her knees.”  The Arbitrator agreed with the respondent’s IME and found that the accident merely cause a contusion to the patella and denied the requested arthroscopic surgery.

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