Thursday, November 13, 2008

Kilwein and Cabela Court of Appeals Cases

Today, the Colorado Court of Appeals issued two workers compensation decisions. Kilwein is an old case where the claimant was permanently and totally disabled with the right to ongoing medical care for the injury. Years later her authorized treating physician underwent utilization review to be replaced as the treating doctor. However though a change of physician was ordered the law allowed the claimant to continue treating with the doctor while he appealed the order. The problem was that the insurance had to keep paying but the risk to the claimant was if the doctor lost his appeal then all medical expenses could be recovered by the insurance. The court decided that the claimant who kept treating with the doctor who was no longer to be authorized did so at her own risk. In this claim the claimant kept treating and also went to referral treatment but all of it was ordered to be repaid to the insurance. This case is a rare situation but points out that if you choose to continue with a deauthorized physician it is at your own risk.
The second case, Cabela, also relates to authorization of a physician and also concerns the insurance saying the injury was not work related. The court quickly disposed of the insurers claim it was not work related by saying the Judge decided that issue on the facts and they would not reverse the judge. More interesting is what happened when the claimant was told by the original authorized physician that her injury was not work related. That doctor decided to send the claimant to her personal doctor. The personal doctor decided it was work related and referred her for treatment by an orthopedic doctor. The appeals court decided that the personal doctor became authorized to treat when the original doctor backed out but sent her to that personal doctor. The mere fact the claim was disputed did not change the fact this was a referral and referrals by authorized doctors are also authorized even if the case is disputed. There is more to the case but it is a good case for claimants. Unlike the Kilwein case there are many disputed cases where the doctor picked to treat you decides it is not work related and then simply closes the matter by saying go to your own doctor.
The Kilwein case.
The Cabela case.

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