What's Hot in Workers' Comp - News and Results*
NEWS
Ben Durstein (Wilmington) presented “The Do’s and Don’ts of Workers’ Compensation Practice” on behalf of the Delaware State Bar Association on May 3, 2022.
Michele Punturi (Philadelphia) presented “The Dawning of the Age of Remote Work” at CLM’s Workers’ Comp and Retail, Restaurant & Hospitality Conference.
RESULTS*
Angela DeMary and Bob Fitzgerald (Mount Laurel, NJ) successfully obtained an order to dismiss with prejudice a medical provider claim petition. The parties were litigating a motion for medical treatment in which a physician was recommending an additional spinal surgery. During the course of the litigation of the motion, the physician moved forward without authorization and performed spinal surgery on the petitioner. In order to complete the surgery, the physician brought in several ancillary services, including a vendor to perform diagnostic monitoring during the surgery. Following the surgery, the medical provider submitted its bills to the carrier, which were rejected based upon the lack of authorization for the surgery. After a medical provider claim petition was filed, the respondent filed a motion to dismiss the matter with prejudice for failure to obtain the requisite statutory authorization. The medical provider argued that it was only providing ancillary services and, therefore, did not require the carrier’s authorization under the New Jersey Workers’ Compensation statute. The medical provider also argued that they were the innocent “victim” since they were advised by the physician that the procedure was authorized. The judge rejected both arguments, holding that all medical providers, including providers that provide ancillary services for surgical procedures, are required to obtain the same authorization for their treatment, or risk not receiving financial reimbursement. The dismissal, to date, has saved the employer almost $32,000 in medical expenses.
Linda Farrell (Jacksonville) took a claim to a final hearing on a compensability issue. The employer/carrier asserted a statute of limitations defense and won at the trial level per an order. Also, Linda previously defeated a claim for permanent total disability benefits on this same claim.
Michele Punturi (Philadelphia) successfully appealed the judge’s decision on behalf of a multi-national retailer, establishing a modification of benefits to partial disability, as opposed to total disability, which was awarded by the judge. This was established through medical evidence and factual testimony of two employer witnesses. This testimony proved that, during the period the claimant was briefly laid off while the employer was closed due to the COVID-19 pandemic, any earning loss fully attributable to the work injury was only partial in nature. Therefore, the claimant was only entitled to earnings for the loss of one day a week attributable to her injury, but not the remaining wage loss attributable to the pandemic closing. As a result, the employer was entitled to a Supersedeas Fund Reimbursement in excess of $8,000.
John Swartz (Harrisburg) successfully defended a claim petition where the claimant alleged he incurred a disabling work-related cervical spine and left shoulder injury. The claim was completely denied by the judge. John presented expert medical testimony, as well as testimony from two employer witnesses, establishing that the claimant was offered modified duty and was discharged for cause, as he violated the employer’s attendance policy. No benefits were awarded as the judge accepted our medical expert’s testimony over that of the claimant’s treating physician’s testimony.
*Prior Results Do Not Guarantee A Similar Outcome
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