May v. Saddleback
Maine Employers' Mutual Insurance Company
February 16, 2016
Pre-Existing Knee IME§312 Ski Lodge
Summary from the Troubh Heisler Attorneys
The panel denied May's pro se appeal of Judge Elwin's decision denying his Petition for Payment of Medical Bills regarding his right knee condition. May had extensive preinjury problems with his knee requiring surgery, before he slipped and fell on ice at work and twisted his knee. May's orthopedic surgeon told him he would ultimately need a total knee replacement and supported his claim that his work injury contributed to his ongoing knee condition.
Dr. Donovan performed a §312 IME and concluded that his work injury was a temporary aggravation of a pre-existing condition and that after surgery he was left with continuing symptoms from his underlying baseline condition alone. Judge Elwin adopted the IME’s opinion over the treating physician opinion, and the appellate panel held that her decision was supported by competent evidence, and that her reliance on the IME was rational. This decision demonstrates both the force of §312 IME's and the difficulty of appealing decisions based on them.