In a series of recently released decisions, the Delaware Industrial Accident Board on appeal consistently upheld the propriety of surgery, overturning the Utilization Review declaration that such surgery was non-compliant with the newly-enacted Delaware Health Care Practice Guidelines. Of the four cases discussed below, only one case affirmed the decision of the Utilization Review examiner:
Bottom Line: In the opinion of this humble blogger, it is not looking good for carriers seeking to second-guess surgery. No doubt these rulings will be peppered with a few exceptions here and there as we see in the Courtney Kenton case. One would also submit that engaging the Utilization Review examiner as an expert in an UR appeal is about as clever as calling the company physician to perform a defense medical evaluation. At first blush the idea would seem to have merit, but Dr. Chenault took a pounding in the Ford case. And as my final observation, I guess the Board envisions there are a few of us out there that are not aware that Dr. Rudin is on the Health Care Advisory Panel or was instrumental in authoring the Health Care Practice Guidelines.
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