LOIS Associate Natalia Verde secured a disallowance in a New York Workers’ Compensation claim where the IME opinion was found to be more credible. The Claimant alleged injury while pushing a cart and causing the cart to bounce back. Per the Employee Claim Form, the Claimant alleged injuries to the back, right leg, and right foot. Prima facie medical evidence was found for the back only, and Verde requested the Claimant’s initial treatment records and cited the IME report, which found that there was no causality. On cross-examination of the Claimant’s treating physician, the Claimant’s doctor conceded that his opinion as to causality was based on the Claimant’s lack of prior low back injuries. The Claimant’s doctor also conceded that he did not review the initial treatment records or diagnostic images. When questioned on the Claimant’s MRI findings which revealed facet hypertrophy, the doctor conceded that this was a chronic finding.
At trial, Verde then took the Claimant’s testimony regarding mechanism of injury. The Claimant testified that while pushing a “heavy” cart and after it hit a piece of metal, the cart bounced back into her abdomen. The Claimant also conceded that in her initial treatment records following the alleged incident, she did not report a back injury. Verde argued for a total disallowance of the claim due to the lack of competent medical evidence of a work-related injury. She argued that the medical evidence and testimony more rationally support the finding that the Claimant’s low back symptoms are idiopathic in nature. Verde relied on the Claimant’s initial treatment records which did not report a low back injury, the low mechanism of injury that the Claimant testified to, and the lack of any evidence of an acute traumatic injury on the MRI.
The Law Judge ultimately disallowed the claim, reasoning that the IME opinion was more credible based on the treating doctor’s failure to review the complete medical history, the insignificant mechanism of injury, the MRI, and IME testimony in that there was no evidence of an acute traumatic back injury. As a result, the Carrier is not liable for indemnity and medical benefits, and the case was closed.
