Anthony Natale III

We successfully defended a Philadelphia-based university in an action by a local medical provider for submissions of compound cream medication. The provider submitted the medication to the carrier via three medical specialists from the same medical group. The first doctor submitted an expensive bill for the compound cream to the carrier for payment. A second doctor from the same office submitted another expensive bill for the same compound cream, allegedly based on an exam that took place on the same day as the first doctor’s exam. Then a physician’s assistant submitted an expensive bill for the same compound medication, allegedly arising out of an exam she had with the claimant on the same day as the first two doctors. The carrier refused payment of the bills and filed a Utilization Review Request against all three providers. The UR requests came back in the carrier’s favor, and the providers’ attorney filed a review petition to challenge the UR determinations. We defended the review by establishing that the providers illegally billed the carrier for exams that allegedly took place on the same day, resulting in the same medication being prescribed and submitted for payment three separate times by three separate practitioners. The judge found the medical providers not to be credible and upheld the UR determination in its entirety.

In a case centered around a marijuana gummy bear, we used a violation of law defense to successfully defend a national can manufacturer in the litigation of a reinstatement petition. The claimant sustained an uncontested crush injury to his foot, which required amputation of one of his toes. The claimant returned to work to his pre-injury job and, sometime later, tested positive for marijuana during a routine employee drug screen. The claimant was discharged for cause thereafter. The claimant filed a reinstatement petition, alleging his total disability arising from his crush injury returned—his treating doctor opined that his work-related condition worsened immediately after his discharge, such that the claimant could no longer perform his duties. The defense cross-examined the claimant’s medical expert, exposing the fact that his diagnoses were unrelated to the accepted work injury. Fact witnesses supported the discharge-for-cause based on the drug violation. The claimant alleged that the marijuana gummy bear was given to him by a friend and that he used it to medicate due to his work injury. He further alleged that he was unaware of the company drug policy. The defense submitted evidence proving the claimant was made aware of the drug policy as contained in the company handbook. The Workers’ Compensation Judge ruled that the claimant was discharged for cause and that the expert testimony of the claimant’s medical witness was not credible. The reinstatement petition was denied.         

We successfully defended a nationally renowned canning and food corporation headquartered in Pennsylvania. The claimant alleged that she sustained an injury to her upper extremities due to repetitive motion at work. She described her duties to include placing slices of cheese on sandwiches and hand-making pizza in an assembly line, which she alleged led to her injuries. The claimant’s medical expert testified that he was told the job duties involved working with jars of mushrooms, repetitively causing the claimant’s injuries. On cross examination, this expert was pinned down as to the mechanics of the claimant’s job duties. The defense then presented fact witness testimony confirming that the claimant did not use her upper extremities at all in performing job duties—contradicting the claimant’s testimony and the expert’s testimony. The Workers’ Compensation Judge concluded that the claimant did not use her upper extremities repetitively at work and dismissed the claim.

We successfully defended a national home décor manufacturer in the litigation of a review petition, which sought to add a cervical disc herniation and surgery to the nature of injury accepted in the case. The litigation had wide ramifications since the same claimant had attempted to reinstate workers’ compensation benefits based on an accepted shoulder/arm injury a year earlier and failed. As a result, the claimant traveled to Florida and underwent cervical disc surgery, claiming it was part of the same work-related injury. The defense proffered medical evidence to support the fact that the surgery and disc herniation were not caused by the work injury and that the medical bills and disability associated with the surgery were, likewise, not work-related.

We successfully defended an eastern regional can corporation in the litigation of a brain injury case. The claimant was struck in the lower extremities by a form of sheet metal which caused him to become unconscious. Nearly three years later, the claimant filed a petition alleging that he sustained a brain injury with post-concussion syndrome and cervical disc herniations as a result of the incident. The defense presented fact witness testimony from the scene of the accident which directly contradicted the claimant’s version of the facts. Moreover, the defense emphasized the weaknesses in the claimant’s medical expert’s opinions on cross examination as to causation. The Workers’ Compensation Judge found the claimant did not sustain a brain injury, post-concussion syndrome or cervical disc herniations related to employment.  

The claimant was a very credible employee who was seriously injured while on a horseback riding excursion at a Continuing Medical Education seminar. While attendance at the seminar was part of the claimant's job, the case evidence focused on whether the horseback riding extracted the claimant from the course and scope of employment. The defense presented fact witnesses from the university who testified that activities undertaken by the claimant outside of the scheduled CME classes (despite fostering camaraderie among the participants) were not within the claimant's course and scope of employment. The Workers’ Compensation Judge accepted our arguments, and the claim petition was denied and dismissed.