In a case arising from a work-related injury in 2001, Harold McCall sought approval for another epidural injection in 2013, a treatment for his chronic pain administered by Dr. David Cosgrove. Good Hope's insurer, Millennium Risk Management, began a review to determine the medical necessity of the procedure. The first review by nurse Debbie Green didn't certify it, leading to a second review by Dr. Ira Posner. The Court scrutinized Dr. Cosgrove's treatment of McCall and while his qualifications were confirmed, concerns were raised about his documentation. The Court acknowledged the benefits of the epidurals for McCall and determined the procedure's medical appropriateness.
The primary dispute arose over whether Dr. Posner, who declined the treatment pre-certification, was indeed Dr. Cosgrove's peer. The Court found him to be so. The Court rejected McCall's argument that Good Hope bypassed certain procedures, ruling their actions complied with Alabama regulations. On the issue of contemptuous breach of standard of care by Good Hope, the Court found no evidence of willful violations. McCall's policy argument was the lack of provision for attorney fees, which could limit injured workers from challenging treatment denials.
The Court ultimately ordered Good Hope to provide the treatment recommended by Dr. Cosgrove. However, they were not held in contempt for the utilization review process issues or for denying treatment to McCall. Good Hope appealed the decision, while McCall cross-appealed on specific issues.
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