Weinmann: When Carriers Ignore Judges' Orders

Monday, June 18, 2018 | 3

When can insurance companies ignore judge's orders? Anytime they want to it appears. The following is a case example. 

Dr. Robert Weinmann

Let's start with the Notice of Hearing dated Dec. 9, 2013. At the bottom of the document is the signature of a workers' compensation administrative law judge. The document says, "Defendants agree to authorize Botox injection."

The decision is made based on a doctor's report dated Aug. 2, 2013. The document also states that the issue at hand is a "dispute resolved by agreement."

Now, four and a half years later, the patient states that the injection has still not been done.  

We are informed by the patient that on May 1,  2018, that the parties again appeared before the same ALJ. We do not have written documentation of the judge's decision from this recent hearing. On the other hand, we have the patient's statement that she still has not had the originally recommended injection that was reportedly agreed upon in the December 2013 hearing. 

The proof of service shows that minutes of hearing were served on the interested parties on Dec. 12, 2013. In this post we're not naming the parties or even the insurance company, since to the best of our knowledge it is not uncommon for insurance companies to ignore judicial orders. 

The clinical information in the actual case is based on medical records and on interview of the patient who was injured in a five-car motor vehicle accident in 1993. The injured party was rear-ended twice and received hospital care. She tried to return to modified work.

When her production didn't match pre-injury standards, she was fired. Treatment and hospitalization were originally accepted by the insurer. Injured body parts were adjudicated, and seemingly were determined to include the lower back, neck, knees and shoulder.

Our documentation reflects diagnoses of cervical disc disorder with myelopathy, and severe disc protrusion at C6-7 with progressive degenerative changes superimposed at the injury site. The clinical note at the time said that patient "needs cervical spine decompression because of increasing spinal cord compression and ... is one fall away ... away from quadraplegia (sic)." 

Her neck surgery was repeatedly delayed and was finally done in August of 2017. 

With reference to the lower back, mention is made of lumbar laminectomy at L5-S1, and that she benefitted from lumbar epidurals and from a caudal block. Patient's left knee sustained meniscal tear. She had three surgeries for right knee meniscal tear. She sustained derangement of the left shoulder. 

Now we have a quizzical situation where the records show that her primary treating physician recommended Botox injection, which was supported by the ALJ whose order, as best we can determine from the medical-legal file, was ignored. 

We would like to know how such a scenario is possible. Is there a next step to be taken by the applicant's attorney or by the Workers' Compensation Appeals Board?

Dr. Robert Weinmann writes the Politics of Healthcare blog, from which this entry was taken with permission.