Idaho Workers’ Compensation Insurance Companies Cannot Rely On Bogus Opinions from their Defense Medical Exam Doctors

By Fred J. Lewis

On December 8, 2016, the Idaho Industrial Commission filed its findings of fact, conclusions of law and order in the Wilson v. Burts Manufacture and Sales and the Idaho State Insurance Fund case. In this case, the claimant had multiple injuries and was not getting better. His treating physician sent him for an EMG or nerve conduction test. The doctor who had performed the nerve conduction test lost all of the raw data but still attempted to read the remaining information he had from the nerve conduction test several weeks later. The claimant’s treating doctor described the EMG test was done in a bizarre fashion and could not be relied upon by any of the physicians examining or rendering opinions in regard to the claimant’s medical condition.

The Idaho State Insurance Fund asked Dr. Chung, a well-known defense medical examiner, to offer opinions as to causation and further medical treatment for the claimant, Mr. Wilson. Dr. Chung relied upon the bizarre EMG test and opined that the claimant had reached maximum medical improvement and needed no further medical treatment.

The claimant’s treating physician had ordered a repeat EMG test to be done. The Idaho State Insurance Fund refused to pay for the second EMG test. The Idaho Industrial Commissioners chose not to adopt the decision by the referee who conducted the hearing and issued their own findings of fact, conclusions of law and order. The Commissioners found that the EMG studies done by Dr. Price were suspect and that Dr. Chung should not have relied upon Dr. Price’s findings and should have authorized the second EMG test to be done as requested by the claimant’s treating physician. Commissioners found that the Idaho State Insurance fund’s actions were unreasonable and ordered them to pay attorney fees to pursuant to Idaho Code 72-804. The Commissioners also ordered that the Idaho State Insurance Fund pay full invoice charges for the claimant’s EMG test that was performed by Dr. Janes, the Tramadol that had been prescribed by Dr. Janes, a TENS unit, and Dr. Janes’s medical charges pursuant to Neel v. Western Construction, Inc., an Idaho Supreme Court case decided in 2009.

The takeaway from this case is that if an Idaho workers ’ compensation Insurance Company relies on bogus medical opinions, their actions can still be found to be unreasonable and they may be required to pay attorney fees for their unreasonable conduct and pay all the medical bills they unreasonably denied.

If you have been the victim of bogus medical opinions offered by insurance company doctors, please stand up for yourself and do not accept them.  I will help you fight these unreasonable medical opinions from the insurance company doctors and help you get the Idaho workers’ compensation benefits that you legally deserve.

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