AMERelied upon · orthopedic
The AME recommended use of a knee brace and endorsed the use of a transcutaneous electrical nerve stimulation (TENS) unit as reasonable and appropriate. He further recommended an interferential stimulation unit if the TENS unit was ineffective, noting that both interferential stimulation units and the H-Wave unit are superior to the TENS unit. He was not persuaded that the H-Wave unit was superior to other interferential stimulation units but endorsed the medical appropriateness of the H-Wave unit as an interferential stimulation device.
The AME's report was central to the decision on the medical necessity of the H-Wave unit, providing a nuanced endorsement of interferential stimulation devices including the H-Wave unit.
From the decision · page 4The orthopedic AME in this matter was Dr. John Warbritton. Dr. Warbritton issued a report
on October 14, 2013. In this report Dr. Warbritton provided his opinion on the H-Wave machine
and its medical necessity as it related to applicant. (Judicial notice was taken of the AME report
dated October 14, 2013 and filed on December 20, 2017.) The AME provided an opinion on the
H-Wave machine and its medical necessity as it relates to applicant. (Dr. Warbritton's AME report
dated October 14, 2013 at 16.) Defendant contends that the AME's determination was that the
machine was not necessary or required in applicant's case. To the contrary, the Findings and Order
dated October 14, 2022 is based on the AME's recommendations which first endorses use of an
electrical nerve stimulator and then recommends inferential stimulation unit. A physical therapy
report dated March 26, 2013 states that applicant has tried a TENS Unit but "feels more relief with
an H-Wave." (Ex. 16 at 57.) Thereafter, on March 29, 2013, Dr.
PTPRelied upon
Dr. Peatman signed forms recommending a trial and continued use of the H-Wave unit after physical therapy and TENS unit trials, indicating the applicant still had pain and did not want a substitute device. His signed reports met the requirements for DWC Form PR-2 and supported the medical necessity of the H-Wave unit.
Dr. Peatman's signed reports were considered substantial medical evidence supporting the lien claimant's burden of proof for the H-Wave unit's necessity.
From the decision · page 4Peatman signs a 30-day Request
for Authorization, one page. (Ex. 1.) On this form, boxes are checked to indicate that physical
therapy, medications, and a trial of a TENS unit has occurred but applicant still has pain and "do
not substitute" another device for the H-wave. (Ex. 1.) The request of the H-wave occurred after
several weeks of physical therapy and after use of a TENS unit. Subsequently, Exhibit 3 is a form
dated May 30, 2013 whereby Dr. Peatman endorses purchase of the H-Wave machine. (Ex. 3.)
Defendant contests that the PT report and the check box forms signed by Dr. Peatman are not
substantial medical evidence to meet lien claimant's burden of proof.