Recent Case Denied Based on Prior Medical Evidence

November 2021

Matthew P. Sheriff

We were victorious at the Arbitrator, Commission and Circuit Court level defending a case based on the opinion of the independent examining physician and the petitioner’s own medical records, in light of the testimony.

The case involved a 61-year-old custodian/mail carrier who alleged a low back injury as a result of “moving a shipment of batteries” on September 14, 2015. The petitioner had prior low back complaints that were downplayed by him during his regular treatment and before the IME physician, Dr. Babak Lami.

The case was denied based on these inconsistencies and prior medical evidence. The petitioner obtained medical treatment based on his post-accident condition, including two separate fusion surgeries to his lower back. The medical disputed and incurred by the petitioner was over $350,000.

Ultimately, the case was tried before an arbitrator in Chicago on November 13, 2018. At the trial, the petitioner continued to downplay his prior back condition and relied on the causal connection opinion provided by the treating physician.

On cross examination, as highlighted by the arbitrator in his decision, the petitioner continued to fight against his prior low back issues and provided inconsistent testimony. This was used in the proposed decision to accent the petitioner’s honesty (or lack thereof) in this regard and led to a finding of no accident arising out of employment and no causal connection between his condition and the alleged accident. Thus, a Zero Award was secured. This allowed the Respondent to avoid liability for over $31,000 in TTD and over $350,000 in medical expenses.

Subsequent to the arbitrator’s decision, the petitioner appealed to the Commission and following briefs and oral argument, the Commission affirmed the decision of the arbitrator on November 21, 2019.

As is his right, the petitioner then filed an appeal with the Circuit Court of Cook County. Again, the parties filed briefs in support of their arguments, and the Commission’s decision was affirmed following oral arguments.

Throughout the process, the finding that the petitioner did not sustain an accident that arose out of the employment and a lack of causal connection stood.

The petitioner then appealed to the Circuit Court and the Decision of the Commission was affirmed. No further appeals were taken.