The claimant had an admitted neck injury in 2017. Prior to MMI, the claimant underwent spinal fusion and the treating physician maintained him on restrictions of no work based on substantial subjective complaints. Respondents were able to obtain very favorable surveillance that caused the treating doctor to significantly question the claimant’s credibility as to his ability to function and he was placed at MMI. The claimant later sought reopening of his claim less than a year after MMI for alleged worsening pain and increased symptoms. Respondents denied the matter and defended by sending the claimant back to the treating doctor for an opinion on worsening of condition. The treating doctor again referenced the prior surveillance in noting that he could not take the subjective complaints at face value. The Administrative Law Judge (“ALJ”) agreed and denied the claimant’s request for reopening crediting the treating doctor’s opinion over the claimant’s IME.
Practice Tip: IMEs are not always needed to make an effective and persuasive defense. Sometimes the best tool (and most cost-effective!) for persuading the ALJ is a long-term treater of the claimant.
Robert Jones v. Qwest Corp and XL Specialty Ins. Co., W.C. No. 5-058-668
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