Causal Relationship for Preauthorized Surgeries: Questioning Causality

It is easy to accept preauthorized surgeries as a foregone conclusion where the site of surgery is established and the procedure is approved by the Medical Treatment Guidelines. However, it shouldn’t be. Earlier in 2019, Goldberg Segalla’s workers’ compensation team won an appeal on this very issue. The claimant underwent preauthorized left shoulder surgery on a file established to the left shoulder for an injury that occurred in 2016. However,
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Get It Right the First Time: Why You Should Not Skimp on an IME Cover Letter

We have all been there. The workers’ compensation law judge has directed the carrier to produce an Independent Medical Examination (IME) within a specified number of days. Somehow, we managed to get the report completed timely, even after many scheduling attempts, cancellations, or claimant no-shows. Then, your IME consultant failed to address the key questions. We can try our best to have the law judge grant the carrier an opportunity
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Combating Injured Workers’ IME Reports

Employers, carriers, and third-party administrators are all too familiar with Section 137 of the New York Workers’ Compensation Law and 12 NYCRR Section 300.2, as they govern Independent Medical Examinations (IMEs). Failure to meet or substantially comply with the necessary requirements of Section 137 puts you at risk of having your IME report precluded by a workers compensation law judge. The same holds true for injured workers when they are
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