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Matthew Bruce Lewis
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Matthew Lewis’s Legal Cases

9 total

  • Extent of Injury - Does The Claimant's Compensable Injury Include A Lumbar Disc Herniation At L3-4?

    Practice Area:
    Workers Compensation
    Outcome:
    Prevailed on extent of injury dispute at DWC
    Description:
    The work comp carrier disputed liability of the claimant's lumbar spine disc herniation at L3-4 because a myelogram showed no abnormality. The claimant was able to obtain expert witness testimony of Dr. Myron Glickfeld who displayed a second myelogram report showing the abnormality. The problem with the first myelogram was an inadequate distribution of dye in the spine. It was impossible for it to show the abnormality. Additionally, the claimant had to overcome the presumptive weight of the designated doctor to prevail. The designated doctor only saw the myelogram report and not the films themselves. Therefore, he was not privy to the myelogram technician's mistakes in conducting the study. The Division of Workers' Compensation determined that the claimant's compensable injury includes the disc herniation at L3-4.
  • Did The Claimant Sustain An Injury In The Course & Scope Of Employment With Resulting Disability?

    Practice Area:
    Workers Compensation
    Outcome:
    Plaintiff prevailed before the DWC
    Description:
    S.G. was injured after clocking out, while walking to the car that arrived to pick her up from work. While stepping off of the curb in front of her employer's building, and while still on her employer's premises, she fell and sustained a serious injury to her ankle and shoulder. X-Rays showed her ankle to be fractured. The workers' compensation insurance company denied liability, claiming that she did not injure herself at work. The carrier determined that it was unwitnessed and therefore did not happen as S.G. described. S.G. had a lot of other serious health issues, and had not worked in many years. She had been on social security disability, and this work accident occurred on her first day at work. It appeared to the carrier to be a fraudulent attempt to obtain benefits. The best evidence in this case was the initial x-ray that was performed on the date of injury. It showed a fractured ankle. It would be unlikely that a person would be at work all day doing strenuous physical labor with a broken ankle. S.G. was placed in a cast and had to use crutches following the accident. The evidence indicates it is more likely that the claimant did get injured that day in that accident as opposed to having a pre-existing ankle injury, therefore the judge ruled in favor of S.G. Regarding disability, the judge found that she has been uable to work due to her injury for the past 18 months. Diagnostic testing was not able to be obtained until recently, and an MRI showed a torn ligament in the ankle. The judge determined that this was one of the reasons why S.G. has not been able to return to work. Even though she has other medical conditions that limit her work ability, the work injury is a reason too, and so S.G. is entitled to workers' compensation benefits called temporary income benefits. The carrier may still file an appeal, so the case has not become final.
  • Extent of Injury - Does The Compensable Injury Include Hill Sachs Fracture, Degenerative Joint Disease & Tendonitis?

    Practice Area:
    Workers Compensation
    Outcome:
    Plaintiff Prevailed Before DWC
    Description:
    J.B. was walking on a raised walkway covered in ice after a storm, when he slipped and fell. The employer was self-insured for workers compensation and denied liabiity of anything other than a shoulder strain. J.B., who had been working a heavy duty position, was now in need of shoulder arthroplasty, and could not get treatment because the insurance company would not allow for treatment of anything other than a strain. A state-appointed designated doctor determined that J.B.'s injury was much worse than a strain. He diagnosed a Hill Sachs fracture, tendonitis, and aggravation of underlying degenerative joint disease. In Texas, if a pre-existing condition is aggravated by a work accident, it becomes part of the work injury. Based on this report, the Judge found that the insurance company was liable for the diagnosed conditions. The only evidence to the contrary was a peer review report (the insurance company hired a doctor to review medical records but not to do an exam). It concluded that J.B.'s problems stemmed from a prior shoulder injury, and were not caused by the work accident. The only problem with that conclusion was that the reviewing doctor listed all of the records he reviewed and he did not see any of the medical records from the prior shoulder injury. There was no way he could know what the prior condition of the shoulder was in order to reach that conclusion.
  • Did The Claimant Sustain A Compensable Injury With Resulting Disability

    Practice Area:
    Workers Compensation
    Date:
    Nov 12, 2008
    Outcome:
    Resolved By Agreement
    Description:
    D.L. was on a break in the outside break area on her employer's premises. For unknown reasons, she fell and landed on the cement in the break area. An ambulance was called and she was taken to the Hospital where she was found to have sustained multiple injuries due to an episode of "syncope." The workers' compensation insurance carrier denied liability alleging that the injury was not sustained in the course and scope of employment. However, in Texas, injuries during breaks while on the employers premises are covered under workers compensation. Even if an employee falls for non work-related reasons (like fainting or passing out that is just random or due to other health issues), the fact that the employee is injured on the employer's premises and strikes the premises of the employer allows for a recovery. In this instance, a state-appointed designated doctor had determined that D.L. did in fact sustain injuries when she fell. The parties were able to reach an agreement to resolve this case. The agreement was that D.L. did injure her neck, shoulder, knees, elbow and wrist. The agreement also stated that D.L. did not injure her low or mid back, ankles, opposite elbow and shoulder, and that the carrier was not responsible for vertigo, syncope, and a cardiac dysrhythmia, none of which the claimant was alleging to be the result of her work injury. Additionally, the carrier agreed to pay temporary income benefits from June 5, 2008, through the date of the agreement. Those benefits will continue until the claimant no longer has disability or reaches maximum medical improvement.
  • Did The Claimant Sustain A Compensable Injury With Resulting Disability?

    Practice Area:
    Workers Compensation
    Date:
    Nov 14, 2008
    Outcome:
    Plaintiff Prevailed Before DWC
    Description:
    M.A. worked as a housekeeper in a hospital where she usually worked in the ER cleaning up trauma rooms between patients, which was fairly strenuous work. She was injured one day when she knelt down and tried to pick up a backboard that had been left on the floor of the trauma room. She testified that she could hardly stand up from that position and had a sharp pain in her low back. The evidence showed that the room was littered with debris that had to be picked up quickly so that a new trauma could be brought in and that M.A. had to sit and let someone else finish the room. A witness statement was obtained from a nurse at the hospital who gave M.A. something like tylenol when she complained of the pain. The workers compensation insurance carrier denied liability for the injury. M.A. had injured her back three years prior and had gotten treatment for about six months following that injury. The carrier argued that this current back problem was related to the prior injury and was not a "new" injury. M.A. treated with the same doctor on both occassions and he indicated the current back problem was in fact a new injury. The judge determined that the evidence proved M.A. sustained a new injury and that this injury resulted in an inability to earn wages from June 23, 2008, through the date of the hearing on November 14, 2008. The claimant has a compensable injury with resulting disability. Kevin Poteete represented Zurich American Insurance Company in this case. His name is not in Avvo so this party could not be added to the case details.
  • Is A Chronic Pain Management Program Reasonable And Necessary Medical Treatment For The Compensable Injury?

    Practice Area:
    Workers Compensation
    Date:
    Oct 28, 2008
    Outcome:
    Settlement
    Description:
    K.W.'s treating doctor recommended that she attend a chronic pain managment program. The workers' compensation insurance carrier denied preauthorization for these services alleging that it was not reasonable and necessary medical treatment. The Division of Workers' Compensation assigned an independent review organization to consider the medical necessity of these services. That review determined that the services were medically necessary, and the carrier appealed that decision to a Medical Contested Case Hearing. At the pre-hearing conference, the parties were not able to resolve the dispute. The carrier indicated that it had hired Dr. Melissa Tonn to testify that the program was not medically necessary. Just prior to the hearing to resolve this matter, the parties were able to reach an agreement. The parties agreed that the chronic pain management program was medically necessary. Additionally, the doctor agreed that he would reduce his bill by 20% for the first ten days of the program to facilitate the agreement.
  • Does The Compensable Injury Extend To Include Depression

    Practice Area:
    Workers Compensation
    Outcome:
    Prevailed At Division of Workers' Compensation
    Description:
    In this case, I represented a medical provider who treated an injured worker but was not paid by the Texas work comp insurance carrier. The injured worker had a back injury that failed to resolve as quickly as it should have. Because of peristent pain that interfered with his functional abilities, the claimant developed depression, and the medical provider treated this with psychotherapy and counseling, all of which was preauthorized as medically necessary treatment. The insurance carrier denied payment to the medical provider arguing that the claimant's depression was not related to the work injury. The carrier hired an expert witness, Dr. Andrew Brylowski, who wrote a report indicating that while the claimant had a mood disorder, it was related to a prior head injury that happened more than 15 years prior. The problem with this opinion, is that the "expert" didn't even review one single medical record from the prior head injury to know what the injury was, what the symptoms were at the time and thereafter, what treatment was provided, whether any psychological issues were present back then or not, or anything else about the nature of the prior injury. His conclusions were completely unfounded and not based upon any evidence that was reviewed by the doctor or placed into evidence at the hearing in this matter. The judge determined that the claimant's depression arose out of and naturally flowed from his current work injury. Therefore, depression is compensable, and the carrier was ordered to pay benefits in accordance with the judge's decision.
  • Should A Medical Provider Be Reimbursed For Physical Therapy To The Lumbar Spine?

    Practice Area:
    Workers Compensation
    Outcome:
    Medical Provider Prevailed
    Description:
    This was a case heard before the State Office of Administrative Hearings. The carrier appealed a medical dispute resolution finding that it was required to pay a medical provider for physical therapy. Dallas Multidisciplinary (DM) had provided physical therapy to an injured workers' low back following a work injury. The Texas workers' compensation insurance carrier denied payment arguing that the treatment was not for the compensable injury. The carrier had accepted a lumbar sprain/strain injury only. The claimant had a herniated disc and some degenerative changes in his lumbar spine. The Division of Workers' Compensation ruled that the carrier was only responsible for the sprain/strain diagnosis. Following surgery and injections, DM provided this therapy. The carrier argued that the therapy was for the herniated disc and degenerative conditions for which the claimant had surgery and injections. The provider argued that the therapy was for the low back generally, and the carrier had accepted a compensable injury to the low back, therefore the treatment was for the compensable injury. There was a question of whether the carrier waived its right to raise an extent of injury defense to reimbursement because that was not on the explanation of benefits. The judge ruled that because the EOB stated payment was not made due to a peer review, it was assumed that that meant extent of injury, as opposed to medical necessity. The ruling was that the carrier did not waive any dispute for denial of payment due to extent of injury. After reviewing the evidence, the judge determined that the treatment provided was to the low back, and the carrier had accepted an injury to the low back. The carrier had the burden of proof to show that the treatment was not related to the compensable injury. Because there was no evidence showing what treatment would be necessary for a sprain/strain as opposed to degenerative conditions, the carrier did not meet its burden of proof.
  • Did The Employer Tender A Bona Fide Offer Of Employment?

    Practice Area:
    Workers Compensation
    Outcome:
    Injured Worker Prevailed At DWC
    Description:
    The issue here is whether or not the employer made a bona fide offer of employment such that the Texas workers' compensation insurance carrier could offset the benefits that would have otherwise been owed. A bona fide offer of employment is an offer of employment made by an employer who agrees to accomodate any restrictions the claimant may have. If the claimant returns to work and earns his pre-injury wages, then the carrier does not owe any benefits as long as the employer continues to make accomodation. If the injured worker declines the offer of light duty, then the insurance carrier gets to take a credit for any wages that were offered and reduce or suspend the benefits that were being paid. Rule 129.6 contains specific criteria that must be met in order for an offer of light duty to be declared a bona fide offer such that a carrier can reduce or suspend benefits. The judge found the offer in this case to be deficient. It did not contain a physical description of the job, although it did specify that the job duties would not exceed the restrictions given by the doctor. Additionally, the offer was made by the adjuster, not the employer. It was signed by the adjuster and mailed by the adjuster. There was no indication in the record that the employer itself was offering anything. Rule 129.6 allows for the employer and the carrier to request work status from the claimant's doctor. It then specifies that an "employer" may make an offer of employment, and that a "carrier" can determine whether or not that offer is bona fide and suspend benefits. In this case, one of the reasons the judge cited for finding that the offer did not meet the requirements of Rule 129.6 is because it was made by the adjuster and not the employer. Therefore, the claimant was determined to be owed benefits for the time period in question.