Frederick S. Freibott was recently successful in obtaining an award from the Industrial Accident Board which held that the insurance company’s worker’s compensation Utilization Review was wrong and ordered the worker’s compensation carrier to pay for the Claimant’s subsequent surgery. The Claimant was injured in 2007 and underwent a double level spinal fusion in August of 2008. The Claimant had a subsequent surgical procedure in November of 2009. The worker’s compensation carrier requested that a Utilization Review be performed. The Utilization Review panel concluded that the medical necessity for the requested surgery did not appear to be established and would not be consistent with the Delaware State Worker’s Compensation Guidelines. The Freibott Law Firm filed an appeal de novo to the Utilization Review and the Industrial Accident Board overturned that determination on March 11, 2011. As a result, the worker’s compensation carrier was ordered to pay the neurosurgeon’s subsequent surgery bill along with the reimbursement of medical expert fees, court reporter fees, and the payment of an attorney’s fee. (Reed v. Union Wholesale, Hearing No.: 1306398, Decision dated March 11, 2011)
Related posts