In a recent win for TPM attorney Ilene Feldmeier, claimant was placed at MMI with 14% whole person impairment based on the DIME's findings and respondents admitted to this rating . Subsequently, claimant argued against the DIME ruling and alleged  a 27% whole person impairment rating . Claimant also argued she was not at MMI and required additional treatment.

 

Based on the opinions of claimant's authorized treating providers and respondents' expert , the Court found that claimant failed to prove she should be placed at a higher whole person impairment rating despite claimant's expert's opinion to the contrary .  The Court also found that claimant remained at MMI and did not require any further treatment for the admitted claim.  The Court ruled in respondents' favor  saving them a large sum of PPD along with the elimination of any claim for future medical treatment.

In a win for TPM attorney Brad J. Miller, an ALJ allowed respondents to withdraw an admission of liability and found that claimant did not suffer a compensable work injury.

 

Mr. Miller's client had originally filed an admission on the case after claimant reported traumatically induced wrist and thumb pain after lifting a heavy trash bag into a can.  After claimant requested surgery and the case was referred for review by counsel, several facts surfaced which suggested that the medical condition itself was not work-related including the following: (1) claimant had severe arthritis in her wrist/thumb as demonstrated on diagnostic testing; (2) an injection performed did not provide any symptom relief which strongly suggested that the condition was long standing instead of being related to a recent trauma; and (3) the treating surgeon had concerns over whether the condition truly was work-related. 

 

Based in part on the evidence above, Mr. Miller recommended to the client that the entire claim be denied with an attempt to withdraw the prior admissions of liability (instead of just denying the surgery).  In other words, the recommendation was to contest the entire claim and the prior admissions filed.  

 

This strategy was recommended even though claimant did not have any evidence of medical treatment prior to the reported work injury.  The specific argument made was that claimant's onset of wrist/thumb pain was simply the ongoing manifestation of a longstanding pre-existing degenerative process instead of being related to the reported mechanism of injury. 

 

This strategy worked well as the ALJ found that the wrist/thumb conditions were not work-related.  Specifically, the ALJ made a finding that the wrist/thumb condition was simply the continuing manifestation of a pre-existing condition and allowed the admissions of liability to be withdrawn.  As a result, the ALJ denied the claim with prejudice. 

 

The lessons learned from this case include the following: (1) a history of prior medical treatment and symptoms is not always required to successfully deny a claim; (2) it often will make good sense to deny the entire claim instead of just the surgery request; and (3) respondents always have the option of withdrawing previous admissions of liability on a case if new evidence is developed.