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Let's face it-Mike Freebery in his cashmere robe is a tough act to follow. So is Wil Davis basking in the glow of his successful defense of a heart attack case (not quite sure what he wears to bed). But along comes James Donovan with a little update on the topic of UR appeals. And is it all that shocking that the UR was reversed in favor of the claimant? Read on-
"I've attached the decision that I just got in a very interesting case that because of my client's pregnancy, being bumped by the board, and my client's emergency oral surgery took almost a year to get before the Board.
My client was recommended a peripheral nerve stimulator by Dr. Lieberman, with a psych eval done by Dr. Dettwyler as required by the Guidelines. The treatment was UR'd and the UR denied the peripheral nerve stimulator (while calling it a spinal cord stimulator) because of Dettwyler's report. When I appealed, the carrier sent my client to Dr. Case who also said that she didn't need a peripheral nerve stimulator because she wasn't in enough pain.
There are a couple of things that jumped out at me in the decision. First, the Board accepted Dr. Dettwyler's testimony in part because no psych expert was called for the defense. The Board did not even consider the UR decision fully because it was never entered as an exhibit at the hearing. Dr. Dettwyler did a great job testifying about his years and years of experience doing these sorts of exams and definitely carried that portion of the case.
Dr. Lieberman also did a great job, thoroughly going through his treatment to show that the peripheral nerve stimulator was not his first option but something he arrived at after eliminating all other treatment options. It didn't hurt that Case admitted he had never seen a peripheral nerve stimulator while Lieberman has done at least 20 of them.
If anyone encounters a problem in the future with the UR denying a psych exam for any sort of treatment, Dettwyler's deposition was very good at laying out the case for exactly what sort of exam should be given and how anything more would just be overcharging the insurance-- I'd be happy to scan it to you out of the file."
That's the Delaware way. Lawyers helping lawyers..... laying aside for the moment their adversarial differences. So I suggest you read the case du jour, Amanda Crumpler v. Ken-Crest Services, IAB#1348570 (3/13/12)....and take James up on his offer for a copy of that deposition.
Irreverently yours,Cassandra Roberts
Visit Delaware Detour & Frolic, a law blog by Cassandra Roberts
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