Ninth Circuit Approves Suspension of Benefits for Claimant Who Refuses to Attend Defense Medical Evaluation

In a recent longshore case, Miken v. ICTSI Oregon, Inc., No. 20-71272 (Ninth Cir. January 13, 2022), the Ninth Circuit approved the suspension of benefits for Claimant who refused to attend the defense medical evaluation.

Miken v. ICTSI Oregon, Inc.

The Claimant sustained a compensable injury and underwent a series of surgeries. The Carrier suspended benefits when the Claimant refused to attend defense medical examinations. On one occasion, the Claimant refused to complete intake paperwork at the physician’s office because his attorney had not reviewed it, so the physician refused to examine the patient.

The claim proceeded to formal hearing and the Administrative Law Judge (ALJ) found that compensation benefits were properly suspended. The Benefits Review Board (BRB) affirmed. On appeal to the Ninth Circuit, Claimant contended the notice provided by the Carrier was deficient. The Ninth Circuit affirmed both the BRB and the ALJ, finding that the Claimant’s refusal was both unreasonable and inadequate. The court held that a a reasonable person would have asked for more information so he could attend the requested examination. The court noted that the Claimant could have ended the dispute merely by indicating his willingness to attend an examination.

ALJ Has Discretion in Evaluating Reasonableness of Claimant to Refuse Medical Examination

The ALJ’s original opinion reflected that the Claimant and his counsel were being intentionally difficult in responding to the Employer’s and Carrier’s requests for medical examinations, and the Ninth Circuit’s decision recognizes the ALJ’s broad discretion in evaluating the reasonableness of a Claimant’s refusal to cooperate with the reasonable request for a medical examination.

Miken v. ICTSI Oregon, Inc., No. 20-71272 (Ninth Cir. January 13, 2022)