THOROUGH INVESTIGATION, DETAILED ARGUMENT LED TO EXCLUSION OF DISPUTED DRUGS FROM MSA

June 2017

A claimant sustained serious injuries to his left arm and right leg when he was struck by an automobile in 2008. His diagnoses included an open fracture of the shaft of the ulna, an open fracture of the shaft of the fibula, and a fractured tibia, as well as a non-union of the tibial fracture. Treatment included an open reduction and internal fixation of the ulna, intramedullary nailing and debridement of the tibia, and multiple physical therapy and orthopedic care visits from July 2008 to October 2014, a period of over six years.

At the time the settlement was approved in September 2014, the claimant continued to receive treatment for right leg pain. This included extensive use of narcotics, which alone were valued at more than $40,000.00 over the claimant's future life expectancy. In our triage for an MSA, we recommended obtaining updated medical evidence, which our team analyzed. The new evidence supported our argument to CMS that the petitioner's ulnar injury had completely resolved and needed no further treatment.

We then relied on the records to argue that the petitioner's extended use of pain medications was no longer related to the claimed injuries, as the petitioner had other co-morbidities for which he was also receiving treatment. Lastly, we were able to obtain a favorable rated age based upon those same co-morbidities, and the higher rated age produced a reduced life expectancy. CMS agreed with these arguments, and approved our reduced MSA proposal in the amount of $17,821.00, which excluded future treatment for the ulna and contained no allocation at all for any medications.