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Tuesday, November 25, 2008
Frustration With A Certain RME Doctor
Yesterday I handled a Contested Case Hearing to determine whether or
not an injured worker had depression resulting from the work injury he sustained. The carrier denied liability for depression.
Prior to the CCH, the carrier exercised its right to a Required Medical Examination and had the claimant examined by a doctor
of the carrier's choice. Unfortunately, the carrier picked a doctor who is rather notorious and has a reputation
for always concluding that the claimant did not get depression or any other psychological problem as a result of the work
injury.
In a Texas workers' compensation claim, if a psychological problem arises
as a result of the pain and functional limitations of the work injury, then the psychological problem becomes compensable
as well. Carriers often file disputes of these diagnoses unnecessarily (see my article on this topic). If this issue comes up, there is usually just one doctor that the insurance companies
hire. I will not state his name here in order to avoid any issues of libel or slander, but if you think he is involved
in your case, feel free to give me a call.
As I said, the carrier got this doc to provide
an opinion. When this doc reviewed the medical records, he provided a list of the records that were reviewed.
He indicated that one of the doctors noted in the patient's history that he had sustained a head injury 17 years ago.
Therefore, this doctor concluded that any depression the claimant had now was the result of that head injury so long ago and
not because of the pain and limitations of his current back injury. The problem was, there was no basis for this conclusion.
The doc's report did not indicate that he had reviewed any medical records of the prior
head injury. The evidence at the hearing did not contain any of these records either. There was no evidence that
even if he had a head injury 17 years ago that any psychological issues resulted. No records of any kind.
So, how can a doc say that a patient's problems are related to something that happened 17 years ago when they have not
reviewed any records at all to know what the situation was 17 years ago? That is preposterous!
Most of the time, this doc says that a patient doesn't have a psychological problem at all. However, this time he
diagnosed the man with a "mood disorder", but then said it was because of the head injury 17 years ago. Is
it any wonder nobody trusts these insurance companies when they hire doctors like this of such ill repute who are void of
any moral values?
It was clear that the judge yesterday understood that the doc's
conclusions had no basis in fact. I sure hope that he rules in favor of the claimant on this one. I can't
stand to see someone get screwed over because of things like this. As I think about it, this doctor should be profiled
by Brett Shipp on Channel 8 News. What a fraud he is.
11:37 am cst
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