Workers' Compensation Case Watch
In Manion v. Northwestern Regional Adult Detention Ctr., the claimant needed a new physician because her doctor was no longer providing pain management. The employer asked a nurse case manager to find a new doctor for the claimant and to obtain a Functional Capacity Evaluation (“FCE”) from the physician. The nurse got an FCE referral from the new doctor and scheduled the appointment. She told the claimant about the appointment in person and left her several message about it. The claimant said she would not attend and cancelled the FCE.
The defendant filed an Employer’s Application for Hearing alleging refusal of medical treatment because the claimant did not go to the FCE. The Deputy Commissioner denied the Application because the scheduled FCE was not medically necessary treatment. On review, the Full Commission cited the longstanding principal that the claimant’s medical treatment is directed by the treating physician and not the defendants. They noted that a claimant is not required to attend an FCE unless it is ordered by the treating physician as a necessary diagnostic test.
The Full Commission said there was no evidence that the new treating doctor found it medically necessary to get an FCE. The doctor did not discuss an FCE with the claimant at any of her appointments. The Full Commission found that the insurer ordered the nurse to obtain an updated FCE and was not advised to obtain it by a medical professional involved in the claimant’s care. The employer's application was denied and the claimant’s benefits were not suspended.
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Jessica Hacker Trivizas is a litigator who focuses her practice on workers’ compensation, defending employers and carriers at the trial and appellate levels. She works with insurance carriers, third-party administrators, and self-insureds. Jessica worked on some of the largest settlements in the country, including the historic NFL Concussion Settlement Program, the BP Oil Spill settlement, and the Reglan/MCP Settlement Program. Her background on these mass claims resolution programs gives her unique insight into the work of claims adjusters.
