A new decision out of the Fifth Circuit Court of Appeal has held that the workers’ comp judge was correct in determining that a report authored by a UR physician who is not licensed in Louisiana is not “competent evidence.” According to court documents, claimant Travis Wilson injured his neck, back and shoulder after falling from a ladder while working for Broadmoor LLC on January 6th, 2013. Conservative treatment with an orthopedist failed to relieve his pain and Wilson was referred to a neurosurgeon (Dr. Gabriel Tender) to determine surgical options; Wilson continued with physical therapy during this time. On February 27th, 2014, Dr. Tender filed a 1010 for an L4 laminectomy. Utilization review physician Dr. Bachman rejected the request and Dr. Tender appealed to the Medical Director, who upheld the denial.
On April 28, 2014, the workers’ compensation judge found that Dr. Bachman was not licensed to practice medicine in Louisiana and thus, his utilization review was not competent evidence. Further, the workers’ compensation judge reversed the Medical Director’s denial on the basis that “the medical evidence submitted … constitutes clear and convincing evidence that the opinion of the Medical Review Director denying authorization for the L4 laminectomy…is manifestly erroneous.” Finally, the workers’ compensation judge ordered Broadmoor to authorize and pay for the requested surgery and necessary medical treatment “attendant thereto.” The Fifth Circuit affirmed last week and awarded additional attorneys fees.
See documents below for further details: