Petitioner claimed a rotator cuff tear injury to her shoulder as the result of repetitively moving patients at work. Treatment records also included a history of a fall at home, and she made her specialist appointment three days prior to the date of her alleged work incident. The claim was denied, but Petitioner continued to treat with Dr. Izquierdo and ultimately underwent surgery to repair the rotator cuff tear.
At hearing, the Petitioner testified that she felt a discrete incident of sharp pain when moving a patient on the date of accident. This testimony was in contrast to the accident report she completed for Respondent, the history she initially gave to her treating physician, and the history provided to the IME doctor.
The court considered several factors when evaluating whether the Commission’s decision was against the manifest weight of the evidence:
1. The Commission’s evaluation of the medical records and testimony: The treating doctor, Dr. Izquierdo, and the IME doctor, Dr. Alturi, both appeared to agree the mechanism of overuse is not a likely cause of the shoulder condition that resulted in the surgery. The Commission determined that the arbitrator’s reliance on Dr. Izquierdo’s opinion, that the work accident increased Petitioner's preexisting symptoms from her previous fall and prompted the Petitioner to seek medical treatment, was against the manifest weight of the evidence.
2. The Commission did not find the Petitioner credible: first, they found she minimized her previous fall at home a month prior to her alleged work accident, despite her injury being significant enough for her to contact a specialist before the date of accident. Second, Petitioner consistently described a gradual onset off pain after a shift of repetitively moving patients to her treating doctor, to the IME doctor, and while completing an injury report. However, Petitioner testified to a sudden onset of pain at hearing.
Take-aways from this case:
When evaluating whether a claim should be denied based on the findings of an IME, there must be something additional in the records that supports the position taken by the IME doctor. In this case, the medical records gave a history of repetitive use and previous injury, in contrast with the Petitioner’s testimony. Additionally, Dr. Izquierdo’s opinion on causation was equivocal.
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