LOIS Senior Associate Stephen T. McLinden successfully argued that a PAR-requested surgery was not related and that the Claimant achieved no further disability and maximum medical improvement in a New York Workers’ Compensation claim. The Claimant alleged a back injury in September 2020, and the initial treatment records indicated that he had already been scheduled for a laminectomy seven days later. In 2022, a treating provider requested to perform causally related lumbar surgery. The doctor reported that this was due to failed back syndrome and post-laminectomy conditions, alleging that this was causally related to the work accident in the PAR requests. The request was eventually granted by the Medical Director’s Office (“MDO”).
In 2023 and 2024, McLinden argued that the resulting disability was not related and that the disputed medical bills should be found in favor of the Carrier. McLinden cited the IME opinion, which found that if the revision surgery was not causally related, then the Claimant had reached maximum medical improvement without any further causally related disability. The Law Judge disagreed, rendering a decision of a temporary total disability and continuing awards.
McLinden appealed, pointing to both surgeries as unrelated, citing the IME. He highlighted the language of the Medical Director’s Office note upon granting Level 3 requests: “This determination does not resolve any outstanding legal issues, such as whether the injury that is the subject of the medical treatment is work-related. The Carrier is still permitted to object to payment based on a legal issue.” Granting procedures by the Medical Director’s Office is final and not subject to appeal, McLinden argued, but a common misconception has pervaded that is contradicted by the MDO’s note itself. Carriers should not and do not surrender defenses on legal issues relating to procedures granted by the MDO. The Board Panel ultimately agreed, ruling that the Claimant “had a significant pre-existing back condition due to a prior injury” and agreed with the IME that the Claimant had achieved maximum medical improvement in 2023, rescinding all awards after that point.
