LOIS Disallows Complex Regional Pain Syndrome on both Procedure and Substance

LOIS Associate Ryan Wallace received a disallowance finding in a New York Workers’ Compensation claim for the diagnosis of complex regional pain syndrome, known as CRPS. CRPS was originally established by the Law Judge, but the Board Panel reversed and ordered depositions per Matter of Lazalee. Then, the Claimant’s medical provider failed to appear at two separate depositions. Because of this, Wallace successfully precluded the provider’s opinion from consideration with regard to the causal relationship of CRPS. Wallace also demonstrated that the Claimant was wrong to rely on another, prior provider for CRPS, as that provider explicitly declined to diagnose the condition due to a lack of expertise. Moreover, that prior doctor could not rely on the IME doctor, as he too stated that he was not comfortable diagnosing CRPS based on the Claimant’s symptoms. Finally, Wallace argued that the Claimant’s treatment records did not allow for a finding of CRPS, according to the requirements noted in the 2022 Medical Treatment Guidelines for Complex Regional Pain Syndrome. As a result, the Carrier is not liable for treatment or indemnity benefits related to the alleged CRPS.