LOIS Senior Associate Olivia Barna and Paralegal Rida Khan successfully secures a disallowance in a New York Workers’ Compensation claim. This is an established claim to the neck, back, and left shoulder following a trip and fall accident. Approximately a year and a half from the accident of record, Claimant sought to amend the claim to include the right shoulder, which Carrier controverted. Attorney Barna requested development of the record and strategically declined to obtain an IME to avoid potential concession on causal relationship. During deposition, the PFME doctor conceded he examined Claimant only once, lacked knowledge of her job duties, reviewed no prior medical records, relied solely on Claimant’s subjective history, and could not definitively relate the right shoulder condition to the work accident.
At the hearing, Claimant testified on the mechanism of injury but conceded that she did not seek right shoulder treatment until over a year and a half post-accident. Moreover, she conceded that she had not reported right shoulder complaints despite initial medical care received. During oral summations, Attorney Barna argued that the Claimant failed to meet the burden of proof, emphasizing the delayed reporting and PFME doctor’s inability to establish causation. The Law Judge upheld the position of Attorney Barna and disallowed the right shoulder as an additional compensable site. As a result of this favorable outcome, Carrier’s exposure is mitigated.
