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Having a Reliable Doctor with Respected Opinions Can Make All the Difference in a Claim

by | Apr 6, 2022 | Claim |

In a case involving the age-old question of whether a claimant’s injuries were caused by and/or related to an accident at work, both the arbitrator and the Commission held in favor of the claimant. See Treating surgeon’s persuasive testimony supports benefit award. Illinois Workers’ Compensation Law Bulletin, Volume 29, Issue 8, June 25, 2021, page 5.[1] The case discussed in the article, Roesch v. Afton Chemical, 29 ILWCLB 83 (Ill. W.C. Comm. 2021), involved a claimant who, while employed at a chemical manufacturing plant as a production officer, was in the process of pushing materials off a conveyor belt, when he injured his back, shoulder, and neck area. The claimant was subsequently diagnosed with both tandem stenosis and aggravation of several previously herniated discs.[2] The claimant’s treating physician, who also happened to be an orthopedic spine surgeon, testified that conservative treatment just did not work for the claimant, and that surgery was medically necessary, with the surgeon performing a three-level cervical fusion within one year of the accident. The claimant’s aforesaid treating doctor then recommended that the claimant undergo lumbar fusion surgery as well, asserting that the need for such an operation was medically necessary and related to the claimant’s workplace accident.[3] However, while the employer’s examining physician, most likely an independent medical examiner (or IME) retained as a sort of hired gun, asserted that the proposed lumbar surgery was unnecessary, the arbitrator was instead convinced by the contrastingly well-supported testimony and opinions of the claimant’s treating physician, based on and/or due to the arbitrator finding that the claimant’s doctor had rendered considerable treatment to the claimant in relation to the work accident, for an inarguably and undisputedly very long period of time, and further also maintained detailed and easily referenced medical records in relation to said treatment. Thus, the testimony of the claimant’s physician carried much more weight and consideration with the arbitrator, than the canned, formulaic opinions offered by the employer’s IME physician.[4] As a result, the arbitrator approved the requested lumbar fusion surgery. The employer of course appealed, but upon review, the Commission affirmed (and adopted) the arbitrator’s decision.[5]

This case illustrates the importance of medical testimony from a reliable, experienced treating physician who, if he or she can gain the respect of the arbitrator, will have his or her medical opinions given greater weight by the arbitrator (and the Commission) as a result, to the obvious benefit of the claimant.

[1]Treating surgeon’s persuasive testimony supports benefit award. Illinois Workers’ Compensation Law Bulletin, Volume 29, Issue 8, June 25, 2021, page 5.

[2]See Id.

[3]See Id.

[4]See Id.

[5]See Id.