Ridgewood Medical P.C. v. MVAIC (6/30/2010)
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At an independent medical examination, the patient complained of right knee and right hip pain and reported receiving physical therapy treatment two to three times a week. The IME physician, however, concluded from the examination that the patient’s knee and hip contusions were resolved and no further treatment would be medically necessary. The applicant rebutted, however, by showing that the patient returned to his doctor for follow-up evaluations after the IME, and at each of these follow-ups, the patient continued to complain of knee pain and objective findings referring to the right knee were noted. Furthermore, at each of the follow-up evaluations, continued physical therapy was recommended. The arbitrator concluded that, “Given that the claimant was evaluated by his treating physician prior and subsequent to the examination by the independent examiner and, given the documented subjective and objective complaints, I defer to the opinion of the treating physician in determining the course of treatment rendered.” Accordingly, the benefits were awarded.

Harmony Medical Care P.C. v. Geico Insurance Company (7/7/2010)
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Two of the three independent medical examiners made positive objective findings of mild cervical and lumbar tenderness with decreased range of motion of the neck in right and left lateral flexion (consistent with the patient’s subjective complaints of neck and back pain, which they also noted). But all three independent examiners deemed the injuries sufficiently resolved to the point that physical therapy was not medically necessary. The arbitrator characterized the two IME doctors as “completely disregarding” their own positive findings, while at the same time conceding that the underlying injuries were caused by the accident. This, the arbitrator said, rendered their opinions that further treatment was not medically necessary less than persuasive.


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