Thursday, July 11, 2013

There were no symptoms

Respondent timely denied the claim based on lack of medical necessity predicated upon the peer review of Dr. Stanley Ross dated 6/13/12. In opining that the underlying surgery was not medically necessary, Dr. Ross stated:  
There are no symptoms or clinical findings related to the left knee until 4/3/12 evaluation where knee joint line tenderness and limited range of motion was noted.  
I find this to be a misrepresentation of the evidence. The report of Orlin & Cohen Orthopedic Associates LLP dated 12/20/11 indicates that the patient had left knee problems and difficulty squatting, kneeling, and climbing stairs. The physical examination of the left knee on that date also revealed an antalgic gate. Is this not a clinical finding? If not, it minimally required some explanation by the peer reviewer. The EIP's entire left leg was afflicted with pain, and he was diagnosed with a crush injury. How can the peer reviewer in good faith state that there were "no symptoms" related to the left knee? This was a serious accident wherein the car flipped over pinning the EIP's left leg. The MRI revealed a tear which was confirmed by the postoperative diagnosis. I find the peer review to be conclusory (not supported by the actual evidence) and completely lacking in credibility (his claim that there were no symptoms or clinical findings associated with the left knee).

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