LOIS Partner Christian Sison and Paralegal Anastasia Hicks-Hunter obtained a favorable trial decision in a New York Workers’ Compensation claim. The claimant reopened a 1995 accident claim, even though she received her permanency award almost 26 years ago. The Medical Director’s Office allowed the claimant to proceed with the procedure due to medical necessity, but LOIS raised a causal relationship defense.
Attorney Sison first noted that the employer had not received bills for treatment that had restarted 25 years after the claim was closed. By asserting that the claimant’s personal insurance should be responsible for the cost of all treatment, the Judge directed the claimant to produce proof that the employer was billed by the healthcare provider. When the claimant could not abide by the judicial direction, Attorney Sison reiterated the employer’s right to cross-examine the treating surgeon in furtherance of its causal relationship defense. Although the claimant lamented the thought of going to trial for a surgical procedure that the claimant had already undergone, the Law Judge agreed that the employer was entitled to develop the record.
At a deposition, the treating deposition conceded that other healthcare providers within his practice received differing histories and accident mechanisms from the claimant. Sison used this testimony to apply relevant legal authority in support of his defense, arguing that the claimant’s expert could only place liability on the employer because the claimant disclosed the 1995 accident five days prior to the submission of the surgery request. The trial judge agreed, finding that the surgery was not related and saving the employer substantial costs related to pre-operative, surgical, and post-operative rehabilitation treatment.
