McConnaughhay, et. al., and Employer/Carrier successful in defense of unauthorized medical treatment

September 25, 2023

The Claimant sought payment for unauthorized treatment from an emergency room and unauthorized treatment from a neurology clinic, as well as ongoing treatment for headaches due to post-traumatic concussion. The initial Petition for Benefits seeking neurological treatment, and referencing post-concussion headaches was filed some five months after the claimant received the referral to neurology and the unauthorized treatment was obtained.  The E/C/SA set up an evaluation with a neurologist, and the neurologist saw the claimant and opined that there were no objective findings, the claimant was at MMI with a 0% and no restrictions, and that no further neurological care was warranted, and noting that there were no objective findings to support the claimant’s subjective complaints.  Claimant obtained an IME with contrary opinions.

On September 14, 2023, the JCC denied the claims for payment of the ER bill, the neurology clinic, and the ongoing neurological treatment.  The adjuster provided uncontroverted testimony that the ER and neurology clinic treatment had not been authorized, and the claimant did not plead or prove self-help or emergency care.  The JCC further denied ongoing neurological care based on the claimant not meeting his burden under Section 440.09 (1), or in the alternative, that he accepted the opinions of the authorized provider over the claimant’s IME.