The claimant, a then 16-year-old female, was injured on August 19, 2002 when the go-kart she was driving flipped over. Pursuant to Notice of Decision, filed August 20, 2003, this claim was established to include reflex sympathetic dystrophy to the right upper extremities (currently known as CRPS). On February 11, 2009, claimant was stipulated to have a “permanent partial disability” and thus, entitled to lifetime indemnity benefits at the permanent partial rate of $162.50, per week.
Subsequently, in 2022, this claim was referred to our office because claimant had submitted a reimbursement request for various treatment/services that did not accompany any corresponding medical evidence, or proof that claimant actually paid for said treatment/services. Specifically, claimant requested payment for childcare costs ($550/week), and authorizations for a home health aide, personal trainer, stellate ganglion blocks and a right thoracic sympathectomy.
After conducting depositions on the medical necessity of said treatments, a Law Judge indiscriminately authorized the home health aide, and personal trainer for an indefinite time; and authorized the thoracic sympathectomy, and stellate ganglion blocks, although the medical evidence demonstrated that claimant did not want to undergo the thoracic sympathectomy and that the stellate ganglion blocks were not providing claimant with any permanent relief.
However, on appeal, LOIS Attorney, Zaraya Wade, was able to successfully assert that claimant lacked competent medical evidence to support the need for a home health aide and personal trainer on an indefinite basis, or the medical necessity of surgery (right thoracic sympathectomy) and stellate ganglion blocks. Due to our strong arguments, and zealous defense, on October 28, 2022, the Board determined that none of the previously authorized services/treatment requests were medically necessary, supported by medical evidence, or consistent with the Medical Treatment Guidelines, and rescinded the authorizations for a home health aide, personal trainer, stellate ganglion blocks and a right thoracic sympathectomy.
