issue with the arbitration decision that of the fee schedule of board versus the negotiated rate as we all know the axe specifically provides that the employers liability in a worker's compensation case is limited to lesser of the negotiated rate the providers charge the schedule amounts in this matter petitioner testified that it was his group health insurance provided by compass group that was in effect as the date of the accident it's that negotiated rate set by that particular provider which is found on the base of the bills we contend that  stipulation specifically states and i quote that by so stipulating employer does not waive any objection it may have as to liability or the reasonableness and necessity of said expenses the stipulation is clear in that it only specifies an agreement as t amount of do under the fischetti all if such is was to be found related by the arbitrator the employer waive none of our defenses with regards to the liability for those amounts in the course of that stipulation it was intended merely as a tool to allow the arbitrator tower records case where it was found that the time was right after this change had been made to the act to at the negotiated rate in that case specifically found that the rates used by the group health insurance award right of the wife of the employee  so the fee schedule stipulation as it was written was to give the arbitrator the only number which is not evident from the face of the bills clearly the bills themselves give you the providers charge the only negotiated rate the employer has ever asked for was the negotiated rate evident on the  those bills the only number which the arbitrator then lacked would be the amount due under the fee schedule which has the parties to agree to an advance it is a matter of well son a law that where a stipulation lays out a fact and then delineates the questions that remain that control in this case the stipulation clearly stipulates to and does and we do not dispute that these are the amounts do you heard the fee schedule but we did not in the course of making that stipulation waive our arguments with regards to our this would be the amount if the arbitrator found that the complaint claim was compensable on all medical issues the arbitrator awarded the fee schedule amount of slightly over one million dollars what we are arguing is that the proper amount should also take into account the negotiated rate where it was a and that the proper award should therefore be the five hundred thirty five thousand eight hundred twenty one dollars and forty three cents as we argued in our brief that the average trader makes no mention of the negotiated rate in his decision and ignores that in his calculations leaving only the very specific award of medical section is very brief or the arbitrator conflated the stipulation as to the amount allowed under the fee schedule with the employer's liability for the same despite the specific statement in the stipulation saying that we do not waive any objection we ability argument in our brief as a manifest weight issue what i'm arguing now is simply that the amount of the medical awarded the arbitrator did not write is award that this is the amount to do per the few schedule or the negotiated rate or per section eighty two of the act he specifically awards the medical as a specific one million dollar number and i it's our contention that that number is incorrect if you are to award the specific number in this case then the negotiated rate has to be except the stipulation specifically says that we do not waive any objection that we have to our liability to those expenses and one of our defenses to our liability for that expense is the negotiat v the issue is not liability for the expenses it's the amount of the expenses  this is you should never have had the stipulation to begin with if you want the protection of the negotiated really do not threaten anything and you would only have to pay for those expenses there were found to be reasonable would be to do knowing under the fee schedule provisions of eight point two it does not say that these are the amounts that would be due and owing after analysis of the fee schedule provisions and the negotiators rate and the provider negotiated rate and the providers charge group if it w it was actually the most unbelievable story that i had heard practicing worker's compensation law for decades it's not possible that when i first introduced by self to them and then tell me that i would be here if you guys can't work this out come back and we'll deal with it we didn't have to deal with it because the stipulation is on it's face plain and simple we presented the battlefield schedule and they don't like the no wiggle room there is no misunderstanding there's no fig this touch no ambiguity and consul employer was fired and if there was any confusion there was a concern about what it is that they were stepping into and  s there are no opinions linking the hepatitis a liver problems kidney problems or kidney stones to the the accident so are there is there medical testimony is there evidence in the record establishing a linkage between those conditions and the the accident the commission found to run from the moment you were eyes were originally to the moment that the record is made totality of every medical condition that this man's metabolic mass was is a consequence of the sepsis that exploded from his elbows shutting down his words and organs and organs and yes there is into it i o  can you point to evidence in the record indicating that a appetite is was caused because a result of those acts of hepatitis i am not prepared as i stand before to with the thousands of pages but with your invitation i could go with reasonable dispatch to supplement that inquiry with a written response well there was recovery made for medical services related to the have titles for the liver problems need problems yes so in the commission is found that everything was related in some way shape or form it is there and and the medical records don't disavow your honor this man's organs were shutting down one after the other after the other after the other months on a tree unconscious yes i submit to you that the record supports that every medical condition from that moment when medical records or i'm telling you that this is smoke and illusion that this argument is not just it's not proper to record a sop the information that you're picking up on is i articulated in my reply did they even reduce any evidence that he didn't require those modifications no no record agreed so then the commission turns around said but we won't give you the modifications because you didn't have a doctor's prescription so the question becomes complex to get into the car so he can go to the hospital and that's really the last time he had consciousness until months later when he wakes up and the testimony before that is he was on the phone calling workers compensation for the employer asking for l r i's putting alluded to accident and what about the medical council connection opinion do all your opinion the every now that was a year or two this by a medical report and did you see what the reports and it said listening to a piece of coal coca cola didn't c i would ask if this is a ministerial function to look at and again to go back to something bill again when with is the presidential nature if an employer can't conduct themselves in this with regards to the negotiated rate we did raise at the commission we have raised this issue at every level of appeal so far as far as the employer not presented evidence the employer did not present a separate group health inventory because one was not needed the only negotiated rate we have ever claimed as the negotiated rate as is evident on the face the bills as submitted by the employee into evidence the bill say paid by blue cross paid by a group health it is very clear from the face of the bill in the employer did not think it necessary on top of that to put in a separate group health inventory since we were not requesting any additional reductions as were the kidney conditions in the have a tie this dr kahn who is the treating physician and specialist specifically states that those conditions are related to petitioners diabetic neuropathy they are no medical opinions in the record at all relieving the kidney conditions in any way shape or form to the sepsis to petitioners back injury even if those are related the employer i think this is a matter of a qualified medical profession i would be needed to render an opinion under what authority which says that is there any case you can refer to all the access that we are required to provide to the medical care as recommended and has been interpreted by the courts to mean the medicare prescribe by the doctors and the treating providers i agree that in the case of physical therapy the employer would therefore be liable by physical therapy rendered by a physical therapist there is nothing in the licensure of the physical therapist and petitioner has presented no evidence to the effect that the licensure of the physical therapist allows them to make any sort of prescriptions including a prescription for home modification the license to sin like this license does not include the authority to prescribe that isn't that a majority that specifically has to be granted by a medical board a physical therapist can recommend four more weeks of physical therapy mean you'd have a difference if a psychologist attempted to prescribe add a band that is outside the ability of their licensure a psychologist is not granted by the state boards the ability to prescribe medication psychiatry as it was  something that needs to be prescribed a prescribe a in my experience i've never seen a perspective that was not prescribed by an orthopedic physician about a north doctor the same i've never seen in orthotic which is not prescribed first by  physical therapist to be able to prescribe i mean prescribe a suit simply a word there can be defined and if you look up the dictionary definition of prescribe it doesn't indicate that it is only something that can be done by someone who is a professional who is certified in a particular area so you store good shading into things that you know aren't necessarily something that jump to mind as being prescriptions such as medication or therapy and you get into something like this this is actually one of those areas that would be a case of first impression through i agree we can find no case as to the substance this case you have to take into account the extent of the licensure in a different scenario given a different set of facts it would if there could be a different argument as to the facts in this case they are presenting the whole modifications and claiming that because the physical therapist involved in the case made those recommendations presented no evidence that a doctor review does or recommended then they present no evidence that the doctor even recommended that the house be reviewed for those modifications well that's the hearing paid too much money for it now or did he didn't need it now so now it comes down to the question of whether it is a man or warhol he can be denied his right to recover these what will come down to here because we the proof we needed were didn't go in and we only have to decide the legal question is the whether as a matter of war one cannot recover for a home remodeling expenses on west those expenses are ordered by a physician or anything yes or the question is you know we can't recover then we form any of the answer that question is yes they can recover it even though it's not prescribed by a doctor we don't have assistants opinions are only valid once they've been reviewed by or in conjunction with the physician there licensure perhaps it's them for making any prescriptions they are unallowed to have care without a supervisory physician so you're a physical therapist a would provide some basis for the other fly in here where opposable therapist suggested modifications even though a non position would be appropriate but i haven't unfortunately had the chance to review that particular case although i would question whether or not a physician ultimately reviewed those that claim for damages that's part of the case since that would be our contention i'm not saying that the physical therapist cannot make recommendations of course th plaintiffs that once or physicians testified that her condition was caused by dependents breach of his duty to diagnose and treat plaintiffs there was an adequate foundation for specter's testimony that was the non physician regarding treatment options that did not require a physician's prescription so in that case they found that the home modifications did not require a physician's prescription and there was no physicians prescription in this case we have no physicians saying he's going to be wheelchair bound by any he he's home he was in a wheelchair for a time period he was in using a cane for a time period there's no physicians saying that even that this needs to be evaluated that was presented by  but the morning of the fall positioner was called by his employer because he had the only set of keys he testified at trial that he was not pressured to come into work he volunteered to come into work because he had the only set of keys for the facility he goes into work he works for several hours he goes to the hospital and that is the last that the employer hears from him he scattered medical records which the employer was able to gather since none are provided by petitioner and there is no evidence the petitioner ever contacted employer between them in the two days before trial when they sent four boxes of medical records was scattered information he has subsets how would he have subs this related to a fall his treating physicians are debating the source of the services for months after the initial incident dr  the c t scan says that up the spine there may be a possible injury of the fall but no abscess to which we can trace the sepsis the infectious disease doctors continually state we don't currently know the source of the substance this goes on and on dr sherman boxes of medical records and you don't get a report overnight we received the report on march second which was the best we could do in light of the time it took even the treating physicians to come to a reasonable diagnosis during all that time  evolving their interpretation of his diagnosis was evolving there was nothing to indicate to the employer immediately that this was all the fault of this fact that he initially had there was no testimony from petitioner that he told his employer when the manager called him the morning of the fall even that he fell down the stairs petitioner's test money was just that mr castro called him to get the keys to him to see where he was to find out about opening the facility and he said he'd come in and open the facility there was no testimony that he told mr castro that he fell down the stairs and the only subsequent testimony is that he tells them he can't get out i'm not feeling well and then they help him to go to the hospital there is no reason for the employer to directly connect this to  other his demonstration as to a good faith basis by a dollar hasn't been spent paying for some workers compensation and it's not true i would ask that you don't we man this case for further proceedings  or information necessary to make it this is some disposition of this case i don't believe the state of the law and eleanor will require expert opinion about simple activities of daily living how