records it may say well this was an onset five days ago we're talking about an injury that occurred in the late ninety's with an m m i dated one thousand nine hundred nine so i don't believe any of the medical records submitted at the a hearing i do support this case and this is a hearing can't be viewed in a vacuum without knowledge that we've been before the appellate court before that their final findings with regard to injuries practices that broke the chain of causal relation in this claim that at the original arbitration and the and the poet court upheld the original commission decision over eighty percent of the post and my medical bills were denied it's clear and that a power the order in the original arbitration order that was mostly adopted by the commission the reasons for that denial were injuries practices it was clear in the record i'm not here to relive again the first case those findings are part of the record  broke the causal connection at some point you know you think yes right then all of a sudden he starts filling up the emergency room claim you know alleging there's complaints related to the earlier injury but there's no medical evidence pinions to support a correct and we believe there is a right or and that's pointed out in the dissent of the commission in the current order before you it's supported by the intern weight steel case that we cited in the reply brief and that is in this case where we have circumstances and a long history because a relation is outside of the round of a layman's knowledge now if we were to have a simple and in those cases expert medical testimony is required to e there is no chain of events that when there is a break in chain of events when there is a break in causal relation when there's extenuating circumstances as i believe there is in this case expert medical testimony is absolutely required and we think th are like i said it petitioners white testified length about the condition before and after of the condition currently it simply doesn't suffice in a case like this expert medical testimony is necessary if you think some point out about petitioners brief and condition after january one thousand nine hundred nine was due to his injuries faxes now the commission goes back its order and again cites to the fact that some bills in the old bills were denied this was not a case of just a simple itemization denial these were two surgeries one included a spinal cord stimulator clearly denied because of the injuries practices and the breaking causal relation because of those injuri and that it also misses the point that in the original record which is pointed out in the original post order and in the original arbitration decision that two doctors a doctor tracing dr carroll at the ridges are part of testimony at the original arbitration stated that the injuries practice car injuries practices cause permanent impairment a permanent change in petitioners condition and we'll never know if he would have ever needed surgery without the injuries practices so it's not a case of well inge there was evidence of injuries practice before this emergency room visit so it's not compensable or if there wasn't evidence before this particular visit so what is compensable it was established that there was permanent damage done so i think that point by the commission also misses the fact that petitioner continues to bear the burden to reconnect that chain of causal relation simply again before the commission to seek additional medical benefits he has open rights but he also bears the burden to prove cause a relation and given the history in this claim i think and an expert medical opinion is vital in the proof of that causal relation without it there is no evidence to support what the commission did in awarding over twenty one thousand dollars in medical bills and hearing and it is clearly against the manifest weight of the evidence responded respectfully request you reverse the decision of the commission and deny those medical bills  got overturned and i was awarded fifty four thousand dollars in medical bills patrick gordon was either pm which was for permanent scenery like that we came before the court in two thousand and ten and i respectfully disagree with the court's order at that time what i had to go of commissioner lindsay refused to hear it saying because this case was still on appeal but i couldn't bring that petition so i waited and then i brought it later and shortly thereafter he has had constant pain when you opposing counsel acknowledges that the order and upon the proper evidence or documentation he would continue to be able to receive it has a very finite point and i believe this board found was there a matter of finding earlier of injurious practice on behalf of the  that's common to i think that calmly would say that's that's from the honesty let me ask you sort of a pointed question is there a reason why no medical opinion was tendered or so on because i think it was as clear as could be based on evidence here to separate out whether the current condition of building which is being treated or how much of it may be of any attributed to the injurious practices by me how much for the company he states three months after him and petitioners prognosis is guarded given the significant pain and destruction he has aristid a grim aggressive treatment isn't it indicated now these current condition of ill being sixty percent is related to the since the injuries were forty percent could be attributable to the injuries practices that were the commission's view the medical expenses petitioner now seeks clearly stem from treatment for his or a city and associated depression rather than for many treatment necessitated by injurious practices and they go on to say based on the wording of the pr that's a general finding we have specific findings that awards all the time and actually a specific award of medical care was considered by the commission in the award in the order for you that was the request that a painting home be authorized that's a right when he goes into the emergency room in the records show he comes in he says my arms her regular i'm depressed whatever he's given medication for pain and depression they come in and testify that's why he went there you know why isn't that enough for the for his depression which i think again that is a statement of the law that petitioner writes despite the fact he is all those rights he's commission's decision was against man in this way or to arguing de novo review here i don't believe so i but we my argument is based on the fact there's no medical expert opinion no medical opinion in the record that supports petitioner's decision now a part of that is the case law of a medical expert opinion being assessed aetate it in this case because of the complicating factors  because causal relation in the matter is not of a layman's knowledge that it's beyond that and that there was a causal relation break despite the fact that petitioners a day writes remain open but this year still had to come back with a causal connection opinion to connect his treatment you know five zero seven after the original arbitration to his original work accident and i think i know i don't know if that's gets a prescription filled in your view you're not going to put it down unless he's got an expert saying this specifically related to the his accident and not to injuries practices judges been broken and had an opinion is required in this case in order to reestablish that causal connection it's not part of the evidence in front of you from the ada evidentiary hearing and again believe it medical and justify every bill you're seeing now because of this break with injurious practices another twenty one thousand at some point there should be some evidence the cambers would be just as there which position every time he shows up you have an open  you know well without a causal relation without a medical opinion to differentiate that that's not in the record and that's why we're here in the case right before in the case right before you we don't have that clarification and that clarification has to come from a medical professional medical expert testimony let me just make another point here i mean in the case before us i mean there will be additional risk or other things i mean the commission differentiated and unite his request for more to be done in this decision that's on review and said he hasn't proved that's medically necessary car but they said we've got sufficient proof in the medical records of the testimony for these emergency room visits right that is that is correct that's what they say but we here because i didn't give him a blank check correct think it's specifically denied the specific request for the pain but as i said i believe the general award of power of care is that of open a rights that is subject to a bur a burden he did not meet here and these bills could have been caused he related by a medical expert opinion in the record is a letter in the a record is a letter petitioners attorney sent to dr tracey requesting a narrative report in the