JCC Grants Neurologist Evaluation but Denies Mid-Back and Treatment Claims

In Buendia Castro v. Young Men's Christian Association of South Florida/Summit Consulting, LLC and RetailFirst Insurance Company, Judge Michael J. Ring addressed consolidated accidents involving a left shoulder injury, a head injury, and alleged back complaints. The claimant sought compensability findings and additional treatment for a recurrent shoulder tear, adhesive capsulitis, mid-back complaints, orthopedic care, and neurologic care.

The JCC found that the recurrent rotator cuff condition was already being treated by the authorized orthopedist and denied a separate order compelling that care. The adhesive capsulitis claim was denied because the treating surgeon had not diagnosed that condition and the judge accepted the treating surgeon's opinions over the claimant's IME on that point.

The mid-back claims were also denied. The order emphasized that the authorized medical records over roughly 22 months documented low-back complaints, but did not support a separate mid-back injury, and the IME opinion was based on the claimant's subjective history without objective evidence or supporting treating-provider documentation.

The neurologic claims were split. The JCC denied neurologist treatment because no authorized physician recommended it and the IME recommendation was based on the claimant's history. But the JCC granted a neurologist evaluation, finding that the claimant had documented headache complaints and treatment at Concentra after the accepted head injury, making an evaluation reasonably required by the nature of the injury.

The order therefore denied most requested benefits, granted only the neurologist evaluation, and reserved jurisdiction to determine employer/carrier-paid attorney's fees and costs tied to that awarded benefit.

Source: Compensation Order