Joseph v. Consulate Health Care d/b/a Hillcrest Nursing & Rehabilitation Center / XL Specialty Insurance Company and Alternative Service Concepts

JCC Forte (Ft. Lauderdale) (Paul Terlizzese) (6-26-2025) – Denied treatment of the right knee and neurologic disorder but awarded a walker. The claimant had a compensable injury to her left knee which resulted in three surgeries. Four years after the accident, she began complaining of right-knee pain and the authorized surgeon, Dr. Riley, prescribed PT and injections for the right knee, which the E/C denied as not a compensable body part. The JCC found no medical documentation of when the right-knee symptoms began and found insufficient medical evidence to support the claimant’s additional arguments that the right knee was compensable due to overuse from the left-knee injury, or under the hindrance doctrine. The claimant was elderly, and she began displaying neurologic symptoms including twitching. Dr. Riley referred her to a neurologist. The E/C authorized Dr. Jose Marquez for evaluation only to address the claimant’s difficulty walking. Dr. Marquez’ examination focused on the involuntary movements in the upper and lower extremities, which Dr. Marquez indicated developed after surgery from the effects of the general anesthesia, or possibly metal poisoning from the surgery. Dr. Marquez recommended a brain MRI, metal allergy testing, and an evaluation at a movement disorder clinic, all of which the E/C denied. The E/C secured an IME with Dr. Cimera, who opined that the claimant had an unrelated progressive neurologic disorder. Dr. Cimera testified that the anesthesia could not have caused the symptoms, because they would have presented immediately, and the onset was more than a year after the last knee surgery. The JCC found that there was no evidence of any reactions to anesthesia after any of the three surgeries, and the JCC also found no evidence of metal allergies, heavy metal poisoning, nor any evidence to link that effect to the surgeries the claimant underwent. The JCC accepted Dr. Cimera’s opinions over Dr. Marquez on the neurologic condition, finding Dr. Marquez’ opinions farfetched and not credible. The JCC denied Dr. Marquez’s recommendations for metal testing, brain MRI and referral to a movement clinic, finding the claimant did not meet her burden to show that the testing and evaluation recommended were reasonably necessary to determine MCC. The claimant also requested a four-wheel walker with a seat and brakes, rather than the two-wheel walker provided by the E/C. The JCC found that the two-wheel walker provided by the E/C was adequate for the compensable left knee, but the JCC also found that the claimant was a fall risk, and all of the doctors agreed that a four-wheel walker with a seat was better for her neurologic condition. Therefore, the JCC awarded the four-wheel walker as a matter of safety, to mitigate potential additional injury to the compensable left knee. Click here to view Order