5/12/2017: Lack of Medical Record Credibility Plays Role in Favorable Defense Outcome

Last Tuesday, May 2, F&P associate Tony Villeral received a favorable decision from the District of Columbia Administrative Hearings Division following a two day formal hearing.

The claimant, a graduate student, alleged to have sustained an accidental work related injury to the low back on 3/15/15 while working part time for the employer. On that date, a co-worker took her chair and when Claimant went to sit, she fell on her buttocks and back.  In addition to  radicular low back complaints, the claimant also alleged she hit her head causing vision, balance and concentration problems, and neck issues resulting in radicular upper extremity complaints.

The claimant’s treating physicians causally related all of the claimant’s symptoms to the work accident, recommended low back surgery, and disabled the claimant from her part time job with the employer and her concurrent job as a research associate for Georgetown.  As a result, she was entitled to wage stacking per the District of Columbia Workers’ Compensation Act.

A formal hearing was held on 10/24/16 and 11/7/16, on the claimant’s request for TTD from 3/16/15 to 3/18/15 and 3/31/16 to the present and continuing; causally related medical treatment including lumbar spine surgery and post concussive therapy and payment of causally related medicals.  Several defenses including causal relationship, reasonableness and necessity, nature and extent and voluntary limitation of income were raised.

The very thorough Compensation Order explained the basis for finding that the claimant was not credible, and rejected the opinions of the treating physicians due to “sketchiness, vagueness and imprecision in the reports”.  Judge Knight explained how Claimant produced a 3/19/15 illegible note with a diagnostic code for a concussion, but the corresponding 3/19/15 and 4/2/15 medical reports from Dr. Mullner state the claimant did not hit her head.  Moreover, it wasn’t until May of 2016 that Dr. Heinke began producing reports indicating the claimant did hit her head, but the treatment was more focused on the low back. The claimant testified that she did not correspond with her treating physician about medical notes at the formal hearing.  However; an email was obtained by the defense indicating the claimant did in fact review her medical records prior to her physician placing them on letterhead.  The Compensation Order findings reflect that the claimant’s communication with her physician resulted in serious credibility issues. Specifically, the treating physician emailed the claimant with medical notes for Claimant’s review and requested Claimant’s approval prior to placing them on letterhead.

Judge Knight also rejected treating physician Dr. McGrail’s opinions because they relied heavily on Claimant’s subjective symptoms in light of the evidence indicating the claimant may be exaggerating her symptoms.   Dr. McGrail noted a new onset of cervical symptoms related to the work injury on 1/12/16, 10 months after the work accident, and diagnosed the claimant with cervical radiculopathy.  Judge Knight felt his reports lacked explanation regarding causal relationship in the face of his minimal physical examination findings.  Specifically, Dr. McGrail failed to explain how the symptoms are related to the work injury in the face of a normal MRI, lack of any previous complaints and his limited findings upon physical examination.

Judge Knight rejected the opinions of the Claimant’s treating physicians in favor of the opinions of the employer’s independent medical evaluators.  Judge Knight indicated that the independent medical evaluations provided by the employer deserved more weight than the treating physicians because they were thorough with clear explanations for findings. Moreover, each of the three IME doctors obtained by the employer independently opined the claimant was exaggerating her symptoms and had nonphysiologic findings.

Ultimately, the Administrative Law Judge agreed with the defense and denied the claim in its entirety, finding that the alleged low back, neck, and post concussive symptoms are not causally related to the work injury and all other issues were therefore moot.