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WINNING RESULTS: LOIS Attorney Zaraya Wade Prevails on Medical Treatment Issue in New York

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were medically necessary, supported by medical evidence, or consistent with the Medical Treatment Guidelines, and rescinded the authorizations for a home health aide, personal trainer, stellate ganglion blocks and a right thoracic sympathectomy.

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We represent insurance carriers, self-insured employers, third party claim administrators, and employers before the New York State Workers' Compensation Board. We handle cases from cradle-to-grave. We want to be by your side, moving cases aggressively to closure from the start of litigation all the way through to settlement.

We only assign one attorney and one paralegal to each case. This means that your team members always have one contact to go to for any questions. We do not have 'hearing attorney' or a 'negotiation attorney' or 'appeal department' or anything else! All of our attorneys handle all of those roles – meaning cases are not 'passed around' as they move through the litigation process. Your risk professional or adjuster always knows who is assigned – because the attorney does not change.

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