old dog

Reversal of Medical Director’s Approval in Louisiana

We recently received a letter from an attorney colleague of ours in Louisiana, Wayne Fontana with Roedel Parsons Koch Blache Balhoff & McCollister, informing us he recently received a judgement out of District 07 which overturned a medical director’s decision approving a $40,000 knee surgery.  Of note, the trial judge “specifically determined that the knee surgery was not in accordance with the medical treatment schedule and thereby overturned the medical director’s approval.”  It has historically been very difficult, if not impossible, to overturn the opinions of medical directors in Louisiana.  This has resulted, in our opinion, in inflated costs of future medical care as unapproved and unnecessary care has to be accounted for at the settlement of a workers’ compensation claim.  Once improper decisions are rendered by a medical director, decisions are typically made to not approach a settlement due to the increased cost to do so. Hello legacy claim.

This reversal is noteworthy as it could open the door for an increased number of successful, and medically appropriate, appeals.  Mr. Fontana said to us via email, “The more people who know that this medical director should be challenged and that, with the right case, his rubber stamp approvals can be reversed, the better.”  To our Louisiana clients, it would be a good idea to review prior unfavorable decisions from medical directors and investigate whether or not you might have a case for a successful appeal.

To view the letter from Mr. Fontana, please click here.