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It is very fitting to feature a case involving UPS this time of year. I stumbled upon Paul Schneider v United Parcel Service, IAB#1283119 (12/1/15) and what makes this case a bit of a “re-gifting” is that it contains what most would think is a well-known and well established proposition as it relates to Utilization Review. Specifically, that referral of medical bills for UR concedes causation and creates a waiver of entitlement to argue lack of causation. Just don’t do it!
What further makes this case a worthy read is the overview of the law on this subject (UR referral and waiver) and the quirky little tidbit of trivia in reply to this question: When has Andy Gelman ever conceded that chiropractic treatment is reasonable and necessary? Apparently he did in this case, which supports my fervent and longstanding belief that those who say that he never delivers a DME which is claimant-favorable are grossly overstating the situation.
Of note is the persuasive fact that Mr. Schneider’s use of chiropractic care allowed him to return to work as a delivery driver for UPS and to avoid the use of narcotic pain meds which would have been prohibitive given his job description. As observed by the Board, “[The treatment] helped to keep Claimant working in a job that undoubtedly challenges him daily in regard to his condition.”
I would caution those who do not follow the case law closely that a referral of the medical for UR concedes causation as to those bills and that treatment…..but is not necessarily a concession of causation for all time.
And if this post saves even one practitioner (or carrier) from referring causally disputed bills to UR, then Paul Schneider has not lived in vain.
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