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When Experts Disagree

In a workers’ compensation claim, the nature of the claimant’s injury is at the forefront of the entire process.  Often, at least two medical professionals are involved in evaluating the injury.  There is the insurance carrier’s physician and there is also the claimant’s treating physician.  Given that some workers’ compensation claims may span years, it is reasonably foreseeable that there may come a time when physicians have conflicting opinions.

The claimant’s treating physician, for example, may conclude that the claimant is still disabled because of the claimant’s decreased range of motion in both arms due to chronic nerve damage.  In contrast, the insurance company’s advising physician may opine that the claimant’s complaints are exaggerated and not supported by an objective, physical examination.

Bring in the Impartial Expert

So what happens when these physicians offer conflicting medical opinions?  Generally, a third independent physician is appointed to conduct an unbiased medical examination.  The employer’s workers’ compensation carrier is especially interested in this crucial aspect of the case because it may terminate the claimant’s benefits if this independent specialist concludes that the medical disability has ceased.

This third physician should be qualified in the appropriate specialty and have no previous knowledge or contact with the case.  The claimant’s attorney should advocate for a well-regarded specialist in the field and research his or her publications.  Some special weight is given to the findings of this third medical specialist because his or her purpose is to resolve the conflict between the physicians.  In considering this third medical opinion, a fact-finder would weigh the completeness of the factual and medical backgrounds relied upon, as well as the thoroughness of the medical rationale offered.  The analysis as to which opinion has the most weight essentially then revolves around the issue of reliability.  In essence, which medical conclusion is the most reliable?

And since reliability becomes the linchpin in the scenario of conflicting experts, the claimant should ensure that his or her treating physician has all the pertinent evidence and information.  The treating physician’s records should reflect that he or she has fully reviewed the same documents, tests and evidence as the other experts involved in the case.  For example, if there is a video of the claimant actively shoveling snow, carrying bricks and lifting a snow blower, then the treating physician’s opinion should directly address why the claimant should be deemed disabled with loss of range of motion in both arms.  Similarly, the treating physician’s last examination should also fall closely in time with that of the third expert’s evaluation to ensure comparative fairness.

To help address this determinative issue, a claimant should seek the advice of a lawyer.  A skilled attorney can ensure that the claimant’s treating physician has had access to all evidence and has completed an updated examination of the claimant.  An experienced Memphis workers compensation lawyer can also coordinate an opportunity for the claimant’s treating physicians to refute any improper statements by the carrier’s specialist or the third expert.

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