All County LLC v. Liberty Mutual Fire Insurance Co. (7/7/2010)
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The patient complained to the treating physician of radiating neck pain, and the treating physician ordered a cervical MRI. The peer reviewer stated that the usual method of management for radiculopathy with no significant neurological loss resulting from cervical disc herniations is non-operative care for some ill-defined period of time. He also stated that many studies have documented a high prevalence of disc abnormalities on imaging of asymptomatic subjects. He cited an article on imaging of the lumbar spine to support this proposition. He further stated that MRIs should be reserved for patients who have signs and symptoms of radiculopathy, who have not responded to conservative treatment. No reference was cited for this proposition. The treating physician attempted to rebut the peer reviewer’s claim in a letter indicating that the MRI was was done to rule out disc injury in the cervical spine. The arbitrator determined that the peer reviewer failed to meet its burden of proof in establishing lack of medical necessity.


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