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The “Account of Symptom Development Strains Credulity”

Happy Friday!

This is going to be a fantastic weekend for all of your humble blogger’s wise and loyal readers.  Years of exposure to the radiation of workers’ compensation has gifted this workers’ comp. attorney with foresight, and he is sure that good times will be had by all these coming days.

With that, allow his humble blogger to send you off with an interesting story.

Recently, through the generous consideration of a reader, I have gotten in my hot little hands the opinion of a workers’ compensation Judge disallowing the lien of a medical group.  Now, to protect the innocent, and to some extent the guilty, I’ll have to refrain from naming names… as much as I might like to.

That being said, the opinion is a fantastic one for highlighting some of the red flags that should go up, especially when dealing with lien claims.

In this case, the allegedly injured worker claimed a pantheon of hurt body parts from head to toe after lifting a tire.  These body parts, of course, included head, neck, shoulders, chest, ankles, hearing problems, abdominal pain, psyche, sleep disorder, depression and sexual dysfunction.  (Folks, again, I do not make these up.  I don’t think I could come up with wackier stories than those that actually go on in the workers’ compensation system.)

Within eight days of this alleged injury, the lien claimant had already run up a bill of over $2,000, including EMG and NCV studies, multiple toxicology studies, and ten supplemental reports as well as 5 PR-2 reports.

Then the referrals started.  Pain management, sleep latency testing, more sleep studies, internist evaluations, etc.

So what were the red flags for the workers’ compensation Judge?

Legalese – in his initial report, the “injured” worker claimed several body parts as compensable consequence.  Legal terms at this stage of the claim should give rise to a lot of concern as it indicates that someone is trying to “game the system” as the kids say.

Laundry-list of body parts – from lifting a tire, which could perhaps be granted as a back injury, every conceivable body part was claimed as injured.  The WCJ aptly noted that the “account of symptom development strains credulity.  There is no plausible explanation of how lifting a tire… caused injury from neck to ankles and chest to hands.”

Applicant didn’t testify – the fact that the applicant did not testify at trial is not always a red flag, but it is definitely worth noting.  When a party refuses to testify, my natural assumption (rebuttable though it is) gravitates towards the fact that the testimony is under penalty of perjury.

Russian Novel of Medical Reports – There is no conceivable reason why there should be more reports than days following an injury.  The fact that fifteen reports were generated eight days after the injury suggests a feeding frenzy for medical bills.

So keep alert, dear readers, because when you’re able to point these red flags out to the WCJ, you’re more likely to get a gem of an opinion such as the one that graces my work desk as this post is written.

Have a good weekend!

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