LOIS Partner Christian Sison and Paralegal Anastasia Hicks-Hunter prevailed at trial on multiple issues representing an Owner-Controlled Insurance Program for a construction site in a New York Workers’ Compensation claim. This claim involved a claimant who produced medical records alleging a complete inability to work and requesting authorization for surgery.
Attorney Sison requested cross-examination of the claimant’s experts on all issues and strategically determined that an independent medical examination was not necessary. The claimant’s experts conceded during depositions that the claimant was independent in performing activities of daily living, did not require any assistive devices to ambulate, and even self-reported an ability to lift weight. In the interim, the Medical Director’s Office upheld the carrier’s surgery denial, prompting the claimant to seek judicial review. At trial, the Law Judge agreed that the claimant did not exhibit a total disability and must now produce evidence that he is mitigating his wage replacement benefits by producing work search proofs, vocational rehabilitation documents, or attendance at a full-time accredited educational institution. Perhaps more significantly, exposure was drastically reduced when Attorney Sison argued that the claimant did not meet his burden of proving that judicial review of the surgery decision had not been met. By highlighting the timeline of treatment and the claimant’s failure to produce new evidence that was required by law, the surgery denial from the Medical Director’s Office was upheld. As a result of this favorable outcome, Carrier exposure was significantly reduced.
