The claimant, Donald Smith, was involved in a motor vehicle accident in 2017, leaving him with multiple injuries that were authorized to be covered by his employer, Sears. There were multiple doctors involved in Smith’s recovery.
Smith filed a Petition for Benefits (PFB) in January 2021, but received no response from Sears, leading to a mandatory state mediation. Following the mediation, all issues were reported to have been resolved. Sears agreed to provide follow-up appointments for the claimant with authorized providers at the earliest possible convenience.
An adjuster attempted to make appointments for the claimant, but the specified doctors refused to continue treatment. Note that the doctors gave no testimony in the case, and there was no evidence as to why the claimant was refused.
Following this turn of events, the claimant filed for a motion to enforce the mediation agreement that had not been upheld. The employer did not provide a formal response, and instead filed a motion to dismiss the claimant’s motion. Their motion was denied, despite their assertion that the claimant had failed to attach a recommendation to continue medical treatment by an authorized provider.
The employer argued that they did not know that the designated physicians would refuse their claimant, before they had agreed to the terms of the mediation agreement. In doing so, the employer was determined to bear the risk of mistake. The court decided that the employer should have confirmed their designated physicians’ willingness to treat the claimant, before entering the contract outlined in the mediation agreement. The employer gave insufficient evidence to their own claims, and they provided no evidence that they could not provide the claimant with alternative physicians specializing in the treatment required.
Motion to enforce GRANTED; E/C ordered to provide appointments with specified or alternate physicians.
Source: The 440 Authority