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Successful Disallowance!

Jul 26, 2020 | MAD News, NYS Workers Compensation

This was a controverted claim by an employee for an alleged injury to the left knee. The issue for litigation which ultimately led to a disallowance of the claim was causal relationship. The claimant claimed to have injured his knee while working. The claimant did not seek treatment until 2 years following the alleged accident, and indicated that he did not seek treatment earlier because he avoids doctors, which raised suspicion for the type of injury being claimed and the typical pain and issues that injury would likely cause an individual. As we reviewed the case further, the history of the accident which was being provided to different physicians, as well as the history provided in claimant’s own testimony, began to create even more inconsistencies, as none of the histories appeared to be the same. In one report the claimant alleged he tripped over an object, in another he alleged he twisted his body when his knee was injured, in another he alleged he was squatting down when he injured his knee, and the inconsistencies continued from there. The diagnoses which claimant had were all diagnoses that could have been caused from other preexisting conditions or by other means, such as running or playing basketball, which were also included in reports from various physicians. The treating physician conceded in cross examination that he was only assuming the claimant’s condition was casually related due to the history provided, and then further conceded that there are many other explanations for which claimant could have these knee conditions which would NOT be work related. The IME doctor was able to maintain their position that the claim is not causally related. We highlighted the inconsistencies in both a memo of law and summations. The Judge ended up finding that the claimant had failed to demonstrate his complaints were causally related to a work injury noting the multiple inconsistencies in the claim. The Judge noted that due to the multiple inconsistencies the claimant’s treating doctor’s opinion on causal relationship was not credible. Additionally, the Judge noted that the fact that the claimant waited two years to treat was not credible. As such the claim was disallowed.

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