Winning Results

LOIS Obtains Disallowance of PTSD and Anxiety Claims by Undermining the Credibility of Claimant’s Medical Witness

LOIS Attorney Kristine Rosales successfully argued in written summations for the disallowance of PTSD and anxiety disorder claims following depositions of the IME and claimant’s medical provider. The claim is currently established for injuries to the neck, back, and bilateral knees, and the claimant was seeking to have the case amended to include PTSD and anxiety disorder. During the depositions, Attorney Rosales elicited damaging concessions from the claimant’s medical witness, which zeroed in on her role in the practice. Said witness ultimately conceded that she did not examine the claimant and that her role was limited to documentation for the clients. Further, she conceded that her documentation was based on another clinician’s examination of the claimant. She even conceded that her role in the practice does not include provision of mental health treatment. While she confirmed that there were mental health diagnoses for the claimant, she could not explain the positive findings indicated in her reports.

In contrast, the deposition of the Carrier’s IME established that the claim for PTSD and anxiety disorder clearly had no leg to stand on. The IME testified to crucial facts indicating that whatever psychiatric deficits the claimant allegedly sustained were resolved. First, claimant returned to work barely a month after the accident. Second, claimant had been working from home but goes into the office when she “feels up for it.” Third, the IME performed a mental status examination scrutinizing each diagnostic criteria for the psychiatric deficits being claimed. Lastly, based on a thorough psychological examination, the IME concluded that the claimant’s mental status examination was unremarkable and claimant was shown to have 0% psychological disability.

Attorney Rosales argued that the IME credibly testified within a reasonable degree of psychological certainty, that there is no causal relationship between the work incident and the diagnoses of PTSD or anxiety disorder based on the mental status examination he performed, as claimant did not meet the diagnostic criteria for these disorders. On the other hand, the claimant’s medical witness was not Board certified doctor, did not examine or treat the claimant, and did not present any proof that claimant was specifically diagnosed for PTSD or anxiety disorder.

The Law Judge agreed with Attorney Rosales’ position argued in summations and disallowed the claims for PTSD and anxiety disorder. As a result of the favorable outcome, the Carrier is not liable for claimant’s incurred psychiatric bills, or any indemnity benefits related to the alleged disability associated with said conditions.

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New York Workers’ Compensation Defense at Lois Law Firm

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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