Amy Bruns v. Sebago, Inc.
June 28, 2021
CategoriesMedical Expenses Board IME Board IME Medical Expenses
Summary from the Troubh Heisler Attorneys
Ms. Bruns developed CRPS to her right upper extremity due to a March 15, 1994 injury. She then developed compensable overuse to the left upper extremity. Since 2001 Ms. Bruns received massage therapy to her left upper extremity and back, which was paid for by the employer.
In 2017 the employer controverted this medical treatment. A Board IME concluded that the massage therapy provided temporary relief only. Because it did not improve her symptoms or function, the Board IME felt the treatment should be discontinued. The employee's primary care provider opined the treatment was necessary to maintain function and pain control. Ms. Bruns testified it helped her maintain her limited ability to function.
The ALJ adopted the 312 IME opinions and denied the petition but then reversed his conclusion on a motion for findings submitted by Ms. Bruns. The ALJ concluded that the 312 IME did not consider whether maintaining a level of functioning was reasonable and necessary. The ALJ further found the primary care provider and employee testimony to be contrary evidence establishing it was highly probable that the record did not support the Board IME conclusions. The ALJ determined that medical care that maintains even limited function is reasonable and necessary.