The Bid Day Post….And a Moment of Wonderment as the Delaware IAB Rules That UR - Certified Treatment Is Unreasonable/ Unnecessary

The Bid Day Post….And a Moment of Wonderment as the Delaware IAB Rules That UR - Certified Treatment Is Unreasonable/ Unnecessary

Sweet Caroline and Bid Day at Auburn

Today is auspicious for two reasons.  First it is "Bid Day" at Auburn University.  Picture above is my Sweet Caroline (in the white eyelet dress) offering a "bid" to her little sister.  And another great Gamma Phi Beta tradition continues.......

Talking about traditions, one was just turned on its head in the arena of medical treatment and UR appeals....... The second auspicious event occurring today is my receipt of Sherri Eger v. Citi Group, IAB# 1324201 (8/9/12) which is, literally, hot off the press.   This case is momentous in that it is what I believe to be the very first UR appeal in which the treatment in question was certified by UR below as Guidelines compliant, and then held by the Board on the Employer's appeal to be unreasonable and unnecessary.

Who are the players, you ask?

Well there is the defense counsel, Gary Baker, of Elzufon Austin, who has apparently ventured where no man has gone before.  That and he is the proud papa of a rescue cat, a happy occasion for me since the two were joined through an ad I placed in Circle of Friends.  Some of you may recall that special little tuxedo cat abandoned on my partner's farm who was, imaginatively enough, named Tux.  Apparently he is now residing with Gary and just living the dream.  That alone would be reason to feature Gary on the Detour & Frolic.

But enough about cats.  We have Gary tackling the usually insurmountable presumption of reasonable and necessary.  The treatment was rendered by Dr. Jeffrey Meyers and Julia Spock of MX Physical Therapy.  The DME doctor was Dr. Robert Keehn who performed a total of four DME's over the last three years.

The outcome?

The physical therapy, acupuncture and injections were deemed unreasonable and unnecessary, notwithstanding the presumption that Guidelines-compatible treatment is reasonable and necessary (this is a rebuttable presumption).  The prescriptions--  Flexeril, Percocet, and Voltaren-were awarded, however.  For the details of Gary's genius (and Dr. Keehn's credibility), read the attached decision.

Just remember-you read it first here.  Heck, it may never happen again.

Irreverently yours,
Cassandra Roberts

Delaware Detour & Frolic   Visit Delaware Detour & Frolic, a law blog by Cassandra Roberts

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