Delaware IAB Denies Surgery to Pinocchio
Today’s post comes to us from Wade Adams of Liberty Mutual. He is our guest blogger and I will leave it to him to tell the tale:
This is a case where Dr. Rudin performed a lumbar fusion on a claimant who had a negative MRI, but positive discogram on an accepted low back sprain. When Dr. Kalamchi opined she was not credible, the employer conducted surveillance. We were able to get a video of the claimant 3 days before the scheduled surgery showing that she was exaggerating her symptoms to Dr. Rudin and to Dr. Balu. This was strong evidence that led the Board to grant Employer’s petition to terminate total disability and to deny claimant’s petition for payment for her surgery.
I have to say the employer took it’s time laying a foundation to show that Dr. Rudin performed an unrelated and unnecessary surgery. Surveillance was conducted before the surgery, and once again after the surgery. Further, it was discovered claimant was working an arguably concurrent part time job for months before she had the surgery. The fact she was working showed she wasn’t in as much pain as she claimed. Also, it didn’t help that claimant testified she missed a second DME with Dr. Kalamchi because she was either in the hospital or home recovering from a hospital stay because the employer had surveillance that showed otherwise. The employer also utilized a Board Certified Radiologist, Dr. Todd Siegal to confirm Dr. Kalamchi’s opinions that claimant had a normal lumbar spine and the operation was done on a normal spine, which should not be done.
This case is important because it shows even when Dr. Rudin performs surgery and testifies it was reasonable, necessary and related, if the employer has enough evidence to show the claimant was not being forthright, his opinion will not carry the day. In the end, the moral of the story is if the claimant isn’t credible, then the treating doctors aren’t either.
Thanks
Wade
PS Thank you to Nancy Cobb and Chris Logullo for helping me refine my arguments. They are wonderful mentors and I hope to be as good as they are when I grow up.
Big thanks to Wade. Nancy and Chris must be so proud of their protégé. For my part, this case tickles me on so many levels. It has all the drama you could hope for to include:
Surveillance
The other job on the down low
The use of an additional expert in the form of a radiologist to comment on the MRI
Dr. Rudin and Dr. Balu being duped by their patient (which just ain’t right)
A daycare called “Corporate Kids” (how cool is that)
It is a rare case that a Petition for surgery is overcome by the defense. Bravo, Wade Adams, and as they say over at Corporate Kids, thank you for sharing Felami Moore v. Corporate Kids Learning Center, IAB Hr’g No. 1393120 (Mar. 9, 2015).
Irreverently yours,
Cassandra Roberts
