{"id":971,"date":"2019-04-15T21:40:17","date_gmt":"2019-04-15T21:40:17","guid":{"rendered":"http:\/\/www.keenanpowell.com\/blog\/?p=971"},"modified":"2019-04-15T21:40:39","modified_gmt":"2019-04-15T21:40:39","slug":"gang-of-seven-insurance-independent-experts","status":"publish","type":"post","link":"https:\/\/www.keenanpowell.com\/blog\/2019\/04\/15\/gang-of-seven-insurance-independent-experts\/","title":{"rendered":"Gang of Seven: Insurance &#8220;Independent&#8221; Experts"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"625\" height=\"419\" data-attachment-id=\"631\" data-permalink=\"https:\/\/www.keenanpowell.com\/blog\/2016\/01\/19\/doctor-shopping-dont-do-it\/medical-stuff\/\" data-orig-file=\"https:\/\/i0.wp.com\/www.keenanpowell.com\/blog\/wp-content\/uploads\/2016\/01\/medical-stuff.jpg?fit=937%2C628&amp;ssl=1\" data-orig-size=\"937,628\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"medical-stuff\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/www.keenanpowell.com\/blog\/wp-content\/uploads\/2016\/01\/medical-stuff.jpg?fit=300%2C201&amp;ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/www.keenanpowell.com\/blog\/wp-content\/uploads\/2016\/01\/medical-stuff.jpg?fit=625%2C419&amp;ssl=1\" loading=\"lazy\" src=\"https:\/\/i0.wp.com\/www.keenanpowell.com\/blog\/wp-content\/uploads\/2016\/01\/medical-stuff.jpg?resize=625%2C419&#038;ssl=1\" alt=\"\" class=\"wp-image-631\" srcset=\"https:\/\/i0.wp.com\/www.keenanpowell.com\/blog\/wp-content\/uploads\/2016\/01\/medical-stuff.jpg?w=937&amp;ssl=1 937w, https:\/\/i0.wp.com\/www.keenanpowell.com\/blog\/wp-content\/uploads\/2016\/01\/medical-stuff.jpg?resize=300%2C201&amp;ssl=1 300w, https:\/\/i0.wp.com\/www.keenanpowell.com\/blog\/wp-content\/uploads\/2016\/01\/medical-stuff.jpg?resize=768%2C515&amp;ssl=1 768w\" sizes=\"auto, (max-width: 625px) 100vw, 625px\" \/><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<p>I\u2019m starting a new series of blog posts devoted to identifying some of the insurance industry\u2019s most frequently-used \u201cindependent\u201d medical examiners. I call them \u201cThe Gang of Seven\u201d. They include: Dr. David Bauer, Dr. Lynne Bell, Dr. Dennis Chong, Dr. Keith Holley, Dr. Stephen Marble, Dr. Patrick Radecki, and Dr. Marilyn Yodlowski. <br><\/p>\n\n\n\n<p><strong>If your insurance company sends you to any of these doctors, beware!<\/strong><\/p>\n\n\n\n<p>First up: Dr. R. David Bauer. OMAC expert. <\/p>\n\n\n\n<p>Dr. Bauer is listed on the web with a site called \u201cForensic\nExpert Witness File\u201d. <a href=\"https:\/\/forensic.org\/find-an-expert\/profile\/1C2F69DF-1051-4A7E-BC95-5A140FA1DFA4\">https:\/\/forensic.org\/find-an-expert\/profile\/1C2F69DF-1051-4A7E-BC95-5A140FA1DFA4<\/a>\nHe practices medicine in Garland,\n Texas. He has been practicing for\nthirty years, first in the air force, and then in Texas. He has no reported disciplinary\nactions nor has he won any awards. See: <a href=\"http:\/\/reg.tmb.state.tx.us\/OnLineVerif\/Phys_ReportVerif_new.asp\">http:\/\/reg.tmb.state.tx.us\/OnLineVerif\/Phys_ReportVerif_new.asp<\/a><\/p>\n\n\n\n<p><u>If you look up his Google rating, you\u2019ll find he has a 1.5 star rating. Some of the comments which I have edited for brevity include<\/u>:<\/p>\n\n\n\n<p>A paid shill\nfor insurance companies\u2026Be mindful that although the evaluation is mandatory; a\nreputable orthopedic surgeon will not make a primary living masquerading as an\n\"Independent\" Medical Examiner. \u2013 Victoria Coghlan<\/p>\n\n\n\n<p>If I could give him negative stars I would. I was referred\nto this quack by my workers comp\u2026.He did not listen to anything I had to say,\nonly telling he knew everything about my injury. He only spent about 10 minutes\nwith me and in the end of the appointment he walked out. \u2026I fell an injured my\nback and shoulders on the job and he has the nerve to tell them it was a\npre-existing condition. I was not having any pain prior to my fall\u2026.Whatever\nyou do... DO NOT see this doctor. \u2013 Laurie Langston<\/p>\n\n\n\n<p>This doctor is paid by Workers Comp Ins to find nothing\nwrong with you. I have three doctors that say I need knee surgery and Prolo\ntherapy for my SI Joint and continued PT for my upper back. This scum bag spent\n20 mins with me and said nothing is wrong with me. \u2013 Beach_Bum5150<\/p>\n\n\n\n<p>I was sent by my issurance company to go see this doctor to\nsee if Im getting the right treatments for my work injury. This doctor is a\njoke he said he went through my entire file and looked at the six diffenent\ndoctors notes and finding. This doctor was paid to say that I no longer need\ntreatments or medications due to my injury and his findings. This guy looked at\nall my MRIS CT SCANS, Molograms etc, and he say that I am exaggerating! Wow\nwhat a joke\u2026.We talked about 30 minutes before he did a 5 minute exam!...\u2013\nSteven Hearn<\/p>\n\n\n\n<p><u>Let's take a look at some of the recent Alaska cases in which Dr. Bauer issued opinions<\/u>.<\/p>\n\n\n\n<p>The earliest case reported with Dr. Bauer testifying in Alaska is 2017. There are approximately thirty cases. These would not include cases in which he issued a report and the employee didn\u2019t fight it or cases that have not gone to hearing yet. Here are some of the cases in which Dr. Bauer testified in Alaska during the past few years.<\/p>\n\n\n\n<p>Before you read the opinions, you\u2019ll notice a trend. Most of\nthe time he is hires by Liberty Mutual. And most of the time he opines that the\nemployee does not need treatment and can go back to work.<\/p>\n\n\n\n<p>Also keep in mind that although Dr. Bauer wrote reports\nstating that these Employees were not entitled to benefits, ten of these\nEmployees won their hearings.<\/p>\n\n\n\n<p><u>Serafin v Denali AK Fed Credit Union and Liberty Mutual<\/u> AWCB 17-0032 (3\/21\/17)<\/p>\n\n\n\n<p>The Employee injured her back\nlifting and moving a small refrigerator at work. She was diagnosed with a\nherniated disc and annular tear.<\/p>\n\n\n\n<p>The insurance company first sent\nher to Dr. Keith Holly, who said the disc injury was caused by gaming at home\nand need for treatment was not work-related. Her treating physician, Dr.\nJohnston at Alaska Spine Institute disagreed.<\/p>\n\n\n\n<p>Dr. Flanum performed a\nmicrodisctomy. <\/p>\n\n\n\n<p>The Second Independent Medical\nEvaluator (SIME), Dr. Coulter, found the injury was work-related and treatment\nreasonable and necessary.<\/p>\n\n\n\n<p>She continued to have pain and\nhad a second surgery. <\/p>\n\n\n\n<p>The insurance company sent her to\nsee Dr. Bauer who concluded the February 24, 2010 work injury was not the\nsubstantial cause of any then-current disability or need for medical treatment,\nincluding surgery.&nbsp;Dr. Flanum disagreed with Bauer\u2019s opinion. The SIME\ndoctor, too, disagreed with Dr. Bauer. After the SIME doctor\u2019s deposition, Bauer\nwrote a rebuttal letter stating<strong>: I do\nnot believe the work injury from February 24, 2010, is the substantial cause of\nthe need for medical treatment from January 19, 2012, through January 31, 2014.\nIn my medical opinion, Ms. Serafin's occasional back symptoms between 2012 and\n2013 were due to the progression of degenerative disease consistent with age.\nThe symptoms from mid-2013, when she had the disk herniation, through 2014 are\ndue to a sudden and unrelated event. Therefore, the 2010 work injury is not the\nsubstantial cause of her disability or need for medical treatment.<\/strong><\/p>\n\n\n\n<p>At his deposition<strong>, Dr. Bauer testified the 2010 MRI study as\nrevealing a disc \u201c\u201cbulge\u201d rather than herniation. He believed the February 24,\n2010 work injury was not the substantial cause of Employee's need for\ntreatment, but only an aggravation of a pre-existing degenerative condition\nwhich resolved<\/strong>. <strong>Because disk bulges\ncan be caused by aging, Dr.&nbsp;<\/strong><strong>Bauer<\/strong><strong>&nbsp;believes the disc bulge was present\nprior to and not caused by the 2010 work injury.&nbsp; Employee had an \u201cage appropriate\u201d&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=mproc&amp;entityId=Iac925dfd475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">spine on the\nimaging<\/a>\u2026.Referencing academic\nliterature, 70-80 percent of studied individuals with one-level disc herniation\nhad no identifiable, known cause. The majority of these injuries are caused by\na \u201cwrong move\u201d or even turning over in bed.<\/strong><\/p>\n\n\n\n<p>The case went to hearing. The Board found Employee credible and her physicians credible. Further, it found that the lack of treatment prior to injury, employee\u2019s credible testimony, the medical records, her doctors\u2019 credible testimony outweighed Holly and Bauer. It held<\/p>\n\n\n\n<p>that the disability and need for\ntreatment was work-related. Ordered Liberty Mutual to reimburse for past\nmedicals.<\/p>\n\n\n\n<p>The Employee won.<\/p>\n\n\n\n<p><u>Bailey v Discovery Construction<\/u>, AWCB 17-0043 (4\/18\/17)<\/p>\n\n\n\n<p>On April 25, 2006, Employee\nstopped his vehicle at a red light and a car struck him from behind. This\ninjury arose out of and in the course of his employment with Employer.<\/p>\n\n\n\n<p>On October 9, 2008, James Eule,\nM.D., examined Employee for his 2006 work injury and said, \u201c[Employee's] injury\nto his neck and his back from my history from his [sic] is likely to both have\noccurred from this automobile accident ....\u201d Dr. Eule opined Employee had a\ncervical disc herniation and herniations at L3-4 and L4-5, and his options were\na microdisectomy or continuing to live with the condition. Dr. Eule also noted\n\u201cphysical therapy and\/or an&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=mproc&amp;entityId=Ic706ad30475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">epidural\ninjection<\/a>\u201d might be more helpful than\nchiropractic treatment.<\/p>\n\n\n\n<p><strong>On May 14, 2016, David&nbsp;Bauer, M.D., performed an EME on Employee in the instant case\nand diagnosed resolved cervical and&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=injury&amp;entityId=I6cf47d33995711de9b8c850332338889&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">lumbar\nstrains<\/a>&nbsp;related to the 2006 work\ninjury, and preexisting vertical and lumbar degenerative changes neither\naggravated nor accelerated by the work injury.&nbsp;He stated treatments after\nDr. Eule's September 22, 2009 examination were unrelated to the work injury,\nand said ongoing narcotic use was related to the 2012 injury.<\/strong><\/p>\n\n\n\n<p>The Employee may have had a good\ncause, but he didn\u2019t win a SIME order because he had filed his request late,\nand he was denied back TTD because he had filed that request late. The Board\nhad ordered that he could file new claims for TTD, TPD and PPI at a later date.<\/p>\n\n\n\n<p><u>Israelson v AK Marine<\/u>, AWCB 17-0064 (6\/6\/17)<\/p>\n\n\n\n<p>The Employee injured his back at\nwork moving pallets. The first insurance doctor said his injuries were\nwork-related. So the Employer got a second evaluation from Dr. Bauer and denied\nall benefits after certain date. Because the case was on hearing only upon the\nissue of attorneys fees, the details of Dr. Bauer\u2019s report are not listed. <\/p>\n\n\n\n<p>However at some point the\nEmployer must have recognized he had a good case notwithstanding Dr. Bauer\u2019s\nreport because it settled for $248,224.85.<\/p>\n\n\n\n<p><u>Adams v Michael Heath<\/u> AWCB 17-0065 (6\/7\/17)<\/p>\n\n\n\n<p>On August 18, 2011, the Employee\nwas injured while doing roofing and construction work. Employee fell from a\nladder supported by cribbing and was unable to move after the fall. Dr. Steven\nJohnson performed a temporary trial&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=mdev&amp;entityId=Ib8f17b28475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">spinal cord stimulator<\/a>&nbsp;(SCS) implant. When the Employee decided he wanted\nto go forward with a permanent SCS, the Employer sent him to Drs. Bauer and\nCong.<\/p>\n\n\n\n<p>Drs. Bauer and Chong opined: All medical treatment so far has been medically necessary and reasonable. Employee reached medical stability after the work injury in August of 2014, though he did have complications  which required treatment. Drs.\u00a0Bauer\u00a0and Chong recommend against implanting a\u00a0<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=mdev&amp;entityId=Ib8f17b28475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">spinal cord stimulator<\/a>, based in part on Employee's history of chronic substance abuse and the current high doses of narcotic pain medications, which they feel would very likely increase complications from this procedure.\u00a0<\/p>\n\n\n\n<p>Further they opined: <strong>Mr. Adams does not have the physical\ncapacity nor the lower limb dexterity to perform the duties of a roofer\/carpenter.\nYes he can certainly work. All individuals with an ASIA\nD L3 neurological level of injury are capable of gainful employment on a\nfull-time basis should they choose to do so.<\/strong> <\/p>\n\n\n\n<p>Dr. Jon Scarpino performed a\nsecond independent medical examination (SIME). He stated: The substantial cause\nof Employee's condition and ongoing need for medical treatment was the August\n18, 2011 work injury for Employer, and that the Employee was a candidate for a&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=mdev&amp;entityId=Ib8f17b28475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">dorsal column\nstimulator<\/a>&nbsp;to try and reduce pain\ncomplaints and need for medication. <\/p>\n\n\n\n<p>The Board found Dr. Scarpino\ncredible and ordered SCS,&nbsp; and further\nthat the Employee was permanently totally disabled (PTD).<\/p>\n\n\n\n<p>The employee won.<\/p>\n\n\n\n<p><u>Gillion v North West Co, Berkshire Hathaway,<\/u> Liberty Mutual 17-0089 7\/31\/17<\/p>\n\n\n\n<p>The Employee injured back\nwrapping pallet. He was treated with epidural steroid injections.<\/p>\n\n\n\n<p>He attended an employer medical\nexamination (EME) with R. David&nbsp;Bauer, M.D. <strong>Dr.&nbsp;<\/strong><strong>Bauer<\/strong><strong>&nbsp;diagnosed\na strain of the lumbar spine and \u201cdegenerative disease of the lumbar spine,\nneither aggravated by, nor accelerated by, the incident in question.\u201d&nbsp;Dr.&nbsp;Bauer&nbsp;indicated Employee's&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=injury&amp;entityId=I6cf47d33995711de9b8c850332338889&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">lumbar strain<\/a>&nbsp;caused the short-term pain from December 10, 2015\nto February 2016, but the work injury would not be the substantial cause of any\nongoing disability or need for treatment except the 12 sessions of physical\ntherapy Employee was participating in. Dr.&nbsp;Bauer&nbsp;also opined Employee would be medically stable with\nno ratable permanent impairment after the 12 sessions of physical therapy, and\nwould be able to perform heavy work with no physical restrictions.<\/strong><\/p>\n\n\n\n<p>Dr. Paul M. Puziss conducted an\nSIME examination of Employee, and supplemented his report with later deposition\ntestimony. Dr. Puziss opined that the work injury was the substantial cause of\nEmployee's past and continuing disability and need for medical treatment, and\nno other cause existed. Dr. Puziss opined Employee was not medically stable,\nand recommended treatment including an L5-S1 facet medial branch block, left\nmedial branch block&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=mproc&amp;entityId=Iaea4eac6475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">radiofrequency\nablations<\/a>&nbsp;at L5-S1 facet and\npossibly L4-5, left sacroiliac (SI) joint local anesthetic and steroid\ninjection, lateral branch block of left SI joint, and left SI joint lateral branch&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=mproc&amp;entityId=Iaea4eac6475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">radiofrequency\nablations<\/a>, as the success of progressive\ntreatments required. Dr. Puziss opined Employee could perform light duty work,\nbut noted that Employee's description of his actual duties was not light\nduty.&nbsp;<\/p>\n\n\n\n<p>Dr. Puziss criticized Dr.\u00a0Bauer<strong>'s<\/strong>\u00a0EME report, noting that Dr<strong>.<\/strong>\u00a0Bauer\u00a0had not performed a Kemp test or a\u00a0<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=mproc&amp;entityId=Ic304aca0475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">Milgram test<\/a>, which might have revealed the conditions and symptoms that Dr. Puziss observed and diagnosed.\u00a0<\/p>\n\n\n\n<p>The Board found that &nbsp;Dr. Puziss conducted a thorough and\nprofessional examination, gave a detailed and well-supported medical opinion.\nDr. Puziss's medical opinions and testimony are credible.<\/p>\n\n\n\n<p>At the hearing, the Employer\nwithdrew its opposition to a number of Employee's claimed benefits.&nbsp;It\nagreed to pay the Employee what it owed him.<\/p>\n\n\n\n<p>The Employee won. <\/p>\n\n\n\n<p><u>Carrico v Peterkin, Liberty Mutual<\/u>, AWCB 17-0132 (11\/22\/17)<\/p>\n\n\n\n<p>The issue was whether\nReemployment Benefits Administrator\u2019s decision should be modified because of\nnew evidence. <\/p>\n\n\n\n<p>Employee worked for Employer as\na driver. He reported that on December 9, 2015 he had injured his right\nshoulder transferring gallons of milk from a pallet to milk crates.<\/p>\n\n\n\n<p>On March 11, 2016, Herbert Bote,\nM.D., performed surgery on Employee's shoulder.<\/p>\n\n\n\n<p>&nbsp;On October 13, 2016, Ms. Cranston sent the job\ntitles to Dr. Bote. Dr. Bote reviewed the job descriptions and predicted\nEmployee would have the permanent physical capacities to perform all three\njobs. &nbsp;Based on Dr. Bote's prediction,\nMs. Cranston recommended Employee be found not eligible for reemployment\nbenefits.<\/p>\n\n\n\n<p>Employee did not recover as\nexpected. On December 1, 2016, Dr. Bote performed a second surgery, and on\nApril 11, 2017, he recommended a total shoulder replacement.<\/p>\n\n\n\n<p>The Employee was seen by\nDavid&nbsp;Bauer,\nM.D., for an employer's medical evaluation (EME).&nbsp;<strong>Dr.&nbsp;<\/strong><strong>Bauer<\/strong><strong>&nbsp;opined the cause of Employee's need for the shoulder\nreplacement surgery was the degenerative changes in his shoulder, not the\nDecember 2015 work injury.&nbsp;<\/strong><\/p>\n\n\n\n<p>The Employee petitioned for\nmodification of the RBAD's eligibility determination based on a change in\ncondition: Dr. Bote\u2019s changed prediction, stating Employee would not have the\nphysical capacities to return to his job at the time of injury<\/p>\n\n\n\n<p>Board ordered remand.<\/p>\n\n\n\n<p>The Employee won.<\/p>\n\n\n\n<p><u>Donnelly v Harnish Group<\/u> AWCB 17-0149 (1\/2\/18)<\/p>\n\n\n\n<p>On November 30, 2016, Employee\nunderwent an EME with Dr.&nbsp;Bauer. <strong>Dr.&nbsp;<\/strong><strong>Bauer<\/strong><strong>&nbsp;diagnosed&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=injury&amp;entityId=I6cf47d33995711de9b8c850332338889&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">lumbar strain<\/a>&nbsp;resolved, substantially caused by the December 12,\n2007 work incident and progressive degenerative disease of the lumbar spine,\nneither substantially caused by nor aggravated by the December 12, 2007\nincident.&nbsp;<\/strong><\/p>\n\n\n\n<p><strong>Dr.&nbsp;Bauer&nbsp;found no causal relationship between the work injury\nand the low back problems that led to Employee seeking treatment in 2015. The\nonce commonly held view that disc degeneration was the result of \u2018wear and\ntear\u2019 from mechanical insults and injuries or aging has been replaced by the\nscientific viewpoint that \u2018disc degeneration\u2019 appears to be determined in great\npart by genetic influences.&nbsp;Although environmental factors also play a\nrole, it is not primarily through physical demands as once suspected .... The\ninjured workers' condition was not secondary to an acceleration or aggravation\ncreated by the December 12, 2007 incident. <\/strong><\/p>\n\n\n\n<p>The Employee won a SIME order.<\/p>\n\n\n\n<p><u>Johnson v Blazy Constructio<\/u>n AWCB 18-0040 (4\/20\/18)<\/p>\n\n\n\n<p>&nbsp;On October 16, 2017,\nEmployee filed a claim for temporary total disability (TTD), a permanent partial\nimpairment rating and benefit (PPI), medical and related transportation costs,\ninterest, and review of a reemployment eligibility determination. The claim\nstates on June 11, 2017 Employee herniated a disc in his back removing heavy\ndebris as part of a demolition project for Employer.&nbsp;<\/p>\n\n\n\n<p>Employee was seen by Dr. Lee,\nwho stated Employee had recently undergone surgery for a&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=disease&amp;entityId=Ic9d55d87475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">herniated\ndisc<\/a>, and that \u201c[t]his surgery was\nmedically necessary and most likely the result of a work-related injury.\u201d Employee\nwas seen by Brian Tureman, PA-C at Kenai Spine in Soldotna, Alaska.\nPA-C Tureman opined Employee's symptoms were consistent with disc herniation\nand are work-related.<\/p>\n\n\n\n<p>On August 30, 2017, David&nbsp;Bauer, M.D., performed an employer's medical evaluation (EME<strong>).&nbsp;Dr.&nbsp;<\/strong><strong>Bauer<\/strong><strong>&nbsp;opined\nEmployee had a&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=disease&amp;entityId=Ic9d55d87475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">herniated\ndisc<\/a>&nbsp;at L2-3, which herniated in the middle of the night as\nEmployee was turning over in bed.&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=disease&amp;entityId=Ic9d55d87475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">Herniated\ndiscs<\/a>&nbsp;occur spontaneously in life, and the substantial portion\nof them do not occur as a result of trauma. In Employee's case, this is a\nspontaneous event, the substantial cause of which\nis unrelated to employment.<\/strong> Although\nEmployee was not yet medically stable, there was no evidence of an impairment\ncaused by work for Employer.&nbsp;<\/p>\n\n\n\n<p>The Employee won a SIME\nevaluation.<\/p>\n\n\n\n<p><u>Henson v Apicda Joint Ventures<\/u>, Liberty Mutual AWCB 18-0044 (5\/11\/18)<\/p>\n\n\n\n<p>The &nbsp;Employee tripped in a freezer container in the\ncourse of his employment and injured his leg and back.<\/p>\n\n\n\n<p>The &nbsp;RBA Designee Penny Helgeson issued an\neligibility evaluation determination finding Employee not eligible for\nreemployment benefits. The determination notes that Employee had filed\ndocuments on March 10, 2016 disputing the \u201clight\u201d classification of the Chef\njob title, but states that the documents did not change the outcome of the\ndetermination. <\/p>\n\n\n\n<p>The &nbsp;Employee was examined by Dr. Kirkham, who\nrecommended Employee find sedentary work, based on the April 20, 2016 FCE. Dr.\nKirkham states \u201c... chef is a light duty position and not a sedentary duty\nposition, so he would not be able to return to work as a chef.\u201d&nbsp;<\/p>\n\n\n\n<p>The Employee attended an EME\nwith R. David&nbsp;Bauer, M.D<strong>. Dr.&nbsp;<\/strong><strong>Bauer<\/strong><strong>&nbsp;found no\nobjective or physiological basis for Employee's pain complaints, no objective\nor physiological reason Employee could not return to his job at the time of the\ninjury, or other heavy-duty work.<\/strong><\/p>\n\n\n\n<p>The Employee won a remand to the\nRBA for modification of her previous denial.<\/p>\n\n\n\n<p><u>Tumenas v Katmailand,Wausau, a Liberty Mutual Company<\/u> AWCB 18-0047 (5\/15\/18)<\/p>\n\n\n\n<p>The Employee reported an injury\nto his lower back that had occurred in June 2008 while working for Employer. <\/p>\n\n\n\n<p>On January 7, 2016, Employee\nfiled a claim for medical benefits and a finding of unfair or frivolous\ncontroversion, stating that the claim had been controverted for unknown\nreasons, and the adjuster and his manager had not responded to calls or an\noffice visit.<\/p>\n\n\n\n<p><strong>Employer and Insurer rely on the IME opinion of Dr.\nDavid&nbsp;Bauer&nbsp;that\nEmployee is medically stable from the work injury and that no additional\nmedical treatment is reasonable or necessary to the process of recovery from\nthe work injury.&nbsp;The work injury is not the substantial cause of\nEmployee's waxing and waning low back symptoms or continued treatment.<\/strong><\/p>\n\n\n\n<p>This may have been a good case,\nbut we will never know. The Employee did not timely comply with deadlines so\nhis case was dismissed.<\/p>\n\n\n\n<p><u>Cavitt v D&amp;D Services and Ohio Casualty Company<\/u> AWCB 18-0060 (6\/25\/18) <\/p>\n\n\n\n<p>The employee fell from scaffolding at work and fractured his\nelbow. &nbsp;He had partial elbow replacement\nsurgery. He had a second surgery because hardware came loose due to osteomyletis\n(infection.) His treating physician recommended continuing follow-ups every\nyear or two because of infection and stated that in future there would be\nadditional surgeries and that he could not go back to the job he was doing at\ntime of injury or subsequently.<\/p>\n\n\n\n<p>On January 25, 2018, Employee\nwas seen by Dr.&nbsp;Bauer&nbsp;for\na second EME. In addition to examining Employee, Dr.&nbsp;Bauer&nbsp;reviewed medical records dated after his April 26,\n2017 EME. Dr.&nbsp;Bauer's&nbsp;diagnosis\nwere unchanged since his April 2017 EME report, and he continued to find the\nwork injury was the substantial cause of Employee's disability and need for\nmedical treatment, and treatment to date had been reasonable and necessary. <strong>However, Dr.&nbsp;<\/strong><strong>Bauer<\/strong><strong>&nbsp;found\nEmployee had reached medical stability as of the date of his examination and\nthe only further treatment needed was a home exercise program and continued use\nof his&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=mdev&amp;entityId=Ica8859d7475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">elbow brace<\/a><\/strong>, although a functional capacity evaluation would aid in\ndetermining appropriate restrictions for future employment. Dr.&nbsp;Bauer&nbsp;rated Employee with an eight percent permanent\npartial impairment.&nbsp;<\/p>\n\n\n\n<p>When the Employee filed a claim\nand took the case to hearing, the insurance company, Ohio Casualty (a Liberty\nMutual company) withdrew its controverson and refused to produce Dr. Bauer for\ntestimony.<\/p>\n\n\n\n<p>The Employee won.<\/p>\n\n\n\n<p><u>Thomas v State of Alaska<\/u>, AWCB 18-0110 (10\/24\/18)<\/p>\n\n\n\n<p>On February 28, 2018, Employee\nwas seen by M. Sean Green, M.D., and R. David&nbsp;Bauer, M.D., for an employer's medical evaluation (EME).<\/p>\n\n\n\n<p>Drs. Green and Bauer reviewed Employee's medical records from before the work injury, including an August 11, 2005 record and a February 16, 2010 record. The next record reviewed was for treatment on January 20, 2017, two days after the work injury, with Teresa Bormann, M.D. Dr. Bormann diagnosed back strain and neck pain and prescribed massage therapy. The report documents several medical records for massage therapy and chiropractic treatment through December 7, 2017 when Employee returned to Dr. Bormann. Dr. Bormann diagnosed a chronic neck muscle strain and referred Employee to Claimant for physical therapy. <\/p>\n\n\n\n<p><strong>Drs. Green and&nbsp;Bauer&nbsp;stated&nbsp;<a href=\"https:\/\/1.next.westlaw.com\/Link\/Document\/FullText?entityType=injury&amp;entityId=Ibaceede6475411db9765f9243f53508a&amp;originationContext=document&amp;transitionType=DocumentItem&amp;contextData=(sc.Default)\">cervical\nstrains<\/a>&nbsp;resolve in a matter of days\nto weeks and there is \u201cno such thing as a chronic muscle strain.\u201d&nbsp;They\nopined all treatment beyond the initial evaluation was neither reasonable nor\nnecessary<\/strong>. <\/p>\n\n\n\n<p>The Employee won a SIME order.<\/p>\n\n\n\n<p><u>Summary:<\/u> If it all kind of sounds the same, that's because it is. The insurance companies, Liberty Mutual and its subsidiaries know they can rely on a report from Dr. Bauer saying what they want to hear: that the Employee wasn't hurt at work at all, or if s\/he was, s\/he has recovered and needs no further treatment and can go back to work. <\/p>\n\n\n\n<p>Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years\nand has dedicated her practice to Workers Compensation representing injured\nAlaskans handling hundreds of cases. <a href=\"http:\/\/www.keenanpowell.com\/\">www.keenanpowell.com<\/a>.<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I\u2019m starting a new series of blog posts devoted to identifying some of the insurance industry\u2019s most frequently-used \u201cindependent\u201d medical examiners. I call them \u201cThe Gang of Seven\u201d. They include: Dr. David Bauer, Dr. Lynne Bell, Dr. Dennis Chong, Dr. Keith Holley, Dr. Stephen Marble, Dr. Patrick Radecki, and Dr. Marilyn Yodlowski. If your insurance <a href=\"https:\/\/www.keenanpowell.com\/blog\/2019\/04\/15\/gang-of-seven-insurance-independent-experts\/\" class=\"more-link\">...continue reading<span class=\"screen-reader-text\"> \"Gang of Seven: Insurance &#8220;Independent&#8221; Experts\"<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[1],"tags":[],"class_list":{"0":"post-971","1":"post","2":"type-post","3":"status-publish","4":"format-standard","6":"category-uncategorized","7":"h-entry","8":"hentry","9":"h-as-article"},"jetpack_publicize_connections":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Gang of Seven: Insurance &quot;Independent&quot; Experts - Keenan Powell, Attorney at Law<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.keenanpowell.com\/blog\/2019\/04\/15\/gang-of-seven-insurance-independent-experts\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Gang of Seven: Insurance &quot;Independent&quot; Experts - Keenan Powell, Attorney at Law\" \/>\n<meta property=\"og:description\" content=\"I\u2019m starting a new series of blog posts devoted to identifying some of the insurance industry\u2019s most frequently-used \u201cindependent\u201d medical examiners. 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