Employees have no duty to cooperate with a nurse case manager sent by the insurance company.
Think of the nurse case manager as an insurance adjuster with a nursing degree because that is what she is. Her job is to minimize the medical benefits paid for an injured worker. She looks for evidence that the injury may not be work-related in an effort to defeat medical benefits.
Cozy Nurse-Doctor Relationship
In Freeman v ASRC, AWCB Decision No 15-0073 (6/26/15). the nurse case manager directed the injured worker from one physician to another with whom she had an established professional relationship - a relationship so cozy that the doctor signed letters that had been written by the nurse as if he had written them himself. The real reason the nurse sent the employee to that doctor was not because she was trying to secure good medical treatment from him but because she was hoping her favorite doctor would say the surgery wasn't needed or that it wasn't work related.
Under the Freeman case, the nurse case manager has a legal duty to inform the injured worker :
of her role, of the adversarial nature of workers compensation (i.e. she is working against him),
his right to decline her assistance
and the possibility and likelihood that the insurance company's and the worker's interest may someday diverge.
If the nurse case manager you're working with hasn't disclosed all this to you got to wonder what's going on.
Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 30 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. A sample of verdicts she has obtained for Employees is found at http://www.keenanpowell.com/past-verdicts-settlements.
All consultations are free. To set up an appointment, use the contact form on this website or call: 907 258 7663.
Scot Youngblood MD is one the go-to insurance experts in workers compensation cases. I’ve blogged about him before – a lot. For more posts about this doctors, see below.
Here is a unique decision regarding an evaluation by Dr. Youngblood, the case of Williams v Employers Insurance Co of Wausau, Dec. No 21-0106 (November 19, 2021). You can read the decision here: D&O 21-0106.pdf (alaska.gov)
Employee Injured at Work
On November 18, 2020, the Employee reported to his doctor that he injured himself at work lifting and twisting. His job required him to repackage six to seven pallets of soda per day. Each pallet had 81 cases. Each case had two 12-packs. He would bland three cases weight 62 pounds and stack them onto pallets about 54 times a day.
Insurance Company Hired Dr. Youngblood
An MRI revealed a disc protrusion. On March 19, 2021, he was evaluated by Dr. Youngblood upon the Employer’s request. He did not look at the MRI. Regardless he diagnosed a lumbar strain with excessive subjective complaints caused by “age, genetics, and the industrial accident.” It was his opinion that the Employee was medically stable three months after his injury, needed no further treatment, and was clear to return to full duty.
On April 16, 2021, the insurance company denied all benefits based upon Dr. Youngblood’s report. On that same day, he was seen by Dr. Fix who diagnosed a L4/5 disc herniation and recommended a partial discectomy.
Employee Filed Claim
On April 27, 2021, he filed a claim with the Alaska Workers Compensation Board. It went to hearing on November 19, 2021. The Employee’s three physicians agreed that his injury was caused by work. Before November 18, 2020, he did not have radiculopathy (pain running down one leg). An MRI after the event showed a herniated disc. He needed surgery. However, Dr. Youngblood was the lone voice who opined that his condition was merely a strain, had resolved, and did not require future treatment.
The Alaska Workers Compensation Board’s Decision
The Board gave the treating physician’s testimony the greatest weight because they had physically examined the Employee, reviewed the MRI, considered his complaints before giving the radiculopathy diagnosis. They all agreed that his job caused his need for medical treatment and disability, that he was not medically stable, and needed back surgery.
The Board was critical of Dr. Youngblood because he merely conducted a chart review, did not personally examine the Employee, and never looked at the MRI. Dr. Youngblood’s excuse for not looking at the MRI was that he was in a busy clinic and it was the adjuster’s job to provide the MRI to him. The Board held “MRIs are essential in determining muscoskeletal issues.” Further it held “Dr. Youngblood’s commitment to provide an accurate medical opinion is questionable, his opinion is given no weight.”
The Board awarded the Employee temporary total disability (TTD) benefits, medical benefits, and travel benefits.
You don’t need to wait until your claim is controverted to speak with an attorney. Find out your rights are and what you should be looking out for.
Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com
All consultations are free. To make an appointment, email: keenan@keenanpowell.com or call: 907 258 7663.
The insurance companies are bringing up Dr. Scot Youngblood for “independent” medical evaluations again.
How “Independent” is Dr. Youngblood?
Dr. Scot Youngblood has become one of the new go-to doctors so called "independent" medical evaluations. There is a reason for that. He can be relied upon to issue an opinion that there was no work injury, or work injury is not the cause of the ongoing need for treatment or disability, or that any problems are caused by “age and genetics.” As of 2017, Also, Dr. Youngblood was performing 15 to 20 "independent" medical evaluations per month which would earn him approximately $85,000 per month. Because of his incentive to curry his opinion to please his insurance employers, his opinion was given less weight. Piasini-Branchflower v Anchorage School District, AWCB Dec. No. 17-0041 (April 11, 2017)
Dr. Youngblood: Pain behavior and symptom magnification
Tobar v Liberty Insurance Co, 447 P 3rd 747 (Alaska 2019). In July 2013, a hotel housekeeper injured her back while lifting a pile of linens. She was taken by ambulance from her workplace to the hospital because she had difficulty walking. An MRI showed a bulging disc in her lumbar spine. She was given an epidural and prescribed physical therapy. In March of 2014, the insurer sent her to see Dr. Scot Youngblood for an "independent" medical evaluation who opined that she had a low back strain in July 2013, had “pain behavior and symptom magnification” and that the work injury was not the substantial cause of her degenerative disc disease. The case went to hearing before the Board in June 2017 where the claimant was not represented by counsel. She lost. She lost again in front of the Commission. The Employee Won.
Dr. Youngblood: Pre-existing degenerative disc disease
Reuer v New Hampshire Ins Co., AWCB Dec. 16-0033 (April 22, 2016). On October 26, 2010, the Employee was injured in a motor vehicle accident as a school bus driver. He reported injury to the neck, back, shoulders, and arms. On July 1, 2015, the Employer sent him to Dr. Scot Youngblood for an an "independent" medical evaluation who opined that he had suffered cervical sprain/strain in the work injury, now resolved and medically stable, and that he had “multilevel degenerative disc disease, pre-existing, age and genetics related” and not caused by the industrial injury. The Board ordered a Second Independent Medical Evaluation (SIME).
Dr. Youngblood: Age, genetics, gender, and obesity
Corona v State of Alaska, AWCB Dec. 20-0032 (May 21, 2020). On June 30, 2017, the Employee reported carpal tunnel syndrome symptoms in both wrists. She was seen by a number of doctors who were uncertain about the diagnosis and treatment. On September 15, 2017, the State sent her to Dr. Scot Youngblood for an an "independent" medical evaluation who opined that her carpal tunnel syndrome symptoms were related to her “age, genetics, gender, and obesity” and not substantially caused by industrial activities on June 3, 2017. In its decision, the Board pointed out that there was no family history of carpal tunnel syndrome and that Dr. Youngblood’s risk-factors did not conform to the statute and case law. The Employee won.
Dr. Youngblood: Age and genetics
Campoamor v Berkshire Hathaway, AWCB Dec. 19-0014 (November 8, 2019). The Employee slipped on melted ice on stairs at work and stopped his fall by grabbing a handrail. He ended up having five shoulder surgeries. His treating physicians also believed that he had injured his neck. The insurer sent him to Dr. Youngblood for an "independent" medical evaluation who opined that “age and genetics” were the cause of cervical disc disease and that there was no further need for shoulder treatment. He also opined that there was no explanation for the continued pain symptoms. The SIME doctor diagnoses a brachial plexus injury. Th Board found that Dr. Youngblood’s opinions were not supported by the evidence and that it did not conform to legal requirements. The Employee won.
Dr. Youngblood: Cannot explain her pain
Longway-Marotta v Liberty Insurance Co., AWCB Dec. No. 17-0137 (December 8, 2017). On August 18, 2016, the Employee was working as a flagger when a bus drove through a construction zone striking her sign paddle, causing right arm and shoulder to hyperextend. She was diagnosed with shoulder impingement and rotator cuff tendinopathy. On November 16, 2016, she was sent to Dr. Youngblood for an an "independent" medical evaluation who opined that she had suffered a sprain which was resolved and required no further treatment. At his deposition, he testified that her subjective complaints of pain were in excess of objective findings (i.e. she is lying) and that her shoulder was not injured at all. He also testified that she had age-related arthritis in her neck and mild rotator cuff tendinopathy “which just means that, you know, like the rest of us, she’s getting older.” He could not explain her pain so the Board gave his opinion less weight and was against the weight of the evidence. The Employee won.
Dr. Youngblood: Age and genetics, psychological issues
Piasini-Branchflower v Anchorage School District, AWCB Dec. No. 17-0041 (April 11, 2017). The Employee, a teacher, slipped on the ice and fell twisting her back neck to hips, also injuring her right knee and right hand on January 2, 2009. The Employer sent her to Dr. Scot Youngblood for an an "independent" medical evaluation who opined that her right knee meniscus tear was preexisting, related to age and genetics, and not related to the fall. He stated that she had multilevel degenerative disc disease, not caused or aggravated by work, and that her ankle sprain and thumb injury were not related. He also found significant psychological issues and there were no objective findings to support her ongoing pain complaints. The Board found that her hand injury and right knee injuries were work-related and specifically discounted Dr. Youngblood’s “age and genetics” causation opinion because it was conclusory, he didn’t understand the mechanics of the fall, and he behaved more like an advocate for the Employer than as an objective medical evaluator. The Employee won.
Dr. Youngblood: Strain resolved, no need for further medical treatment
Contreras-Mendoza v Alaska National Insurance Co, AWCB Dec. No. 18-0023 (March 6, 2018). On January 21, 2016, the Employee twisted her left ankle during a work basketball game. She was diagnosed with a peroneus brevis tear and surgery was recommended. On October 21, 2016, the Employee sent her to see Dr. Scot Youngblood for an an "independent" medical evaluation who opined that her ankle strain was resolved and medically stable, that her subjective complaints were in excess of objective findings, and she did not need treatment. The Board ordered a Second Independent Medical Evaluation (SIME).
Dr. Youngblood: Pre-existing knee problems
Blakeslee-Edwards v State of Alaska, AWCB Dec. No 16-0097 (October 27, 2016). The Employee, who suffered from cerebral palsy, tripped at work on April 28, 2008, December 14, 2011, and February 10, 2012. On March 20, 2014, her Employer sent her to see Dr. Eugene Wong and Dr. Scot Youngblood for an an "independent" medical evaluation. They concluded her knee problems were pre-existing. The Board ordered a Second Independent Medical Evaluation (SIME).
Dr. Youngblood: Age, genetics, and inherent foot anatomy
In Lena v Fred Meyer Stores, AWCB Dec. No 16-0135 (December 30, 2016), Dr. Younblood's an "independent" medical evaluation report stated that the Employee’s shoes could not have caused her condition (without examining the shoes) and the potential causes were “age, genetics, and inherent foot anatomy”. He opined she was medically stable, and needed no further treatment. His opinion was given less weight because of the inadequate basis.
Moral of the Story
There are two morals of this story:
Dr. Youngblood’s opinion will be used against Employees,
The Alaska Workers Compensation Board, more often than not, does not agree with his opinions.
If the insurance company in your case is sending you to see Dr. Youngblood for an an "independent" medical evaluation, it is because it plans to controvert your benefits. You should collect all your medical records and find an attorney now.
Keenan Powell has practiced Workers Compensation law in the State of Alaska for nearly 40 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. http://www.keenanpowell.com/past-verdicts-settlements
