Who says you can’t successfully deny a Spinal Cord Stimulator (SCS)?

Pollart Miller partner Christin Bechmann recently secured an order at hearing denying implantation of a spinal cord stimulator (SCS).

Claimant sustained a compensable low back injury in 2015 when a lift upon which he was working was hit by a crane.  He was eventually examined by Dr. Barolot who diagnosed him with chronic and severe pain syndrome affecting the lumbar nerve roots and thoracic spine.  Dr. Barolot opined that Claimant was a “ideal candidate” for an SCS.  Respondents appropriately denied the SCS and the matter proceeded to hearing.

Dr. Barolot testified as an expert in the field of neurosurgery and neurostimulator implantation.  He opined that claimant’s nerve roots were “damaged” but he did not address in his testimony whether Claimant met the criteria for implantation under the Medical Treatment Guidelines (MTG).   Respondents obtained an IME with Dr. Lesnak who the ALJ noted was Level II Accredited (unlike Dr. Barolot).  Dr. Lesnak testified that  Claimant did not meet the criterial for an SCS under the MTG, and that the tests implemented to determine Claimant’s pathology were non-diagnostic.  The ALJ detailed in his order the language of the MTG in support of his conclusion  that the SCS would not be reasonable and necessary medical care.

The ALJ specifically noted that he had considered the Claimant’s  argument that Dr. Barolot had great experience with SCS implantation. However, the ALJ found that the totality of the evidence supported that Dr. Lesnak’s testimony was simply more persuasive than the testimony of Dr. Barolot.  The ALJ denied the request for the SCS.

Claims Representation Pointer:

Recommendations for a Spinal Cord Stimulator should be reviewed to ensure that the criteria of the MTG have been met prior to any approval being provided.  A Level II Accredited physician with an understanding of the Medical Treatment Guidelines is an ideal candidate to fully examine if authorization is appropriate.

SFFCLO WC 4-971-01 (January 17, 2018, ALJ Nemechek)

Would you like to know more? Contact Christin Bechmann at cbechmann@pollartmiller.com or 720.488.9586

 

From the February 2018 Pollart Miller Newsletter

2019-01-29T09:17:58+00:00