justices who are counsel peter runs on behalf of the pellet siemens building technology siemens is here on this appeal this very narrow appeal with one issue that it complains namely an order for prescribed care given by the commission modifying an otherwise decision by the cook the arbitrator on a consolidated that respondent argues she's mia polling argues the commission did not have the power to issue and also was against the manifest weight of the evidence i first addressed the issue of claim to care of law with the order of the commission specifically stating that it's the commission's view that the respondent have should have followed up on the recommendation of its section twelve examiner that the petitioner undergo a neuro psychological evaluation you were portion itself also refers to the order of our recommendation for that to occur having been recommended by dr land off so it's your position isn't really the argument that limitation but this is an important point because the relationship with the patient physician relationship never began in this case with this particular patient this is important because implantation manufacturing when this court struggled with whether or not prescribe as opposed to recommended care was incurred under section eight and it decided that when the physician patient relationship begins when there is a prescription for care notwithstanding the fact that it has not yet been performed its incurred under the act our argument here is that no such prescription for care can occur and therefore cannot be position is that under section eight psychological care from a treat or can be can be prescribed not yet performed and incurred and therefore ordered by the commission about what cannot occur what is the on the bottom section twelve and also in one thousand seat is a recommendation not a prescription or recommendation for psychological care for any medical care but the commission may then order and the reason for this is  follows the court implantation addressed its attention specifically to the term in section eight incurred the patient physician relationship must have been estab all prescribe not recommended but prescribe and not yet done it was determined to be incurred section twelve does not have any provision whatsoever for prescription and in fact the issue here is larger th prescribing treated it but it doesn't it doesn't say that but it doesn't it doesn't say that in a serious her state medical surgical services and all necessary medical surgical hospital services thereafter incurred women however that which is reasonably required to cure or relieve the effects of the accidental injury now this doctor recommended this test for a reason that this doctor recommended this test for reason under section twelve for the purpose of the respondent assessing the nature of extent problem duration of compensation owed under the act this doctor from the very first time that he saw the patient made it clear that the patient police determined whether you have something inside of it is for the following reason that it is because if there's a certain medical and psychological protocol involved with this it takes several hours to perform it's conducted under certain psychological condition stukas the test is the same even though it's to determine the condition of the patient but the condition of the patient once arrived at in diagnosed by a section twelve examiner can be done a diagnosis can be arrived at under section twelve but unless there's a position physician patient physician relationship no prescription for the care can be given and therefore it cannot be incurred under section eight  that what that doctor record man's becomes a valid prescription well to things must happen one there must be a choice by the patient to treat and two there must be a consent to treat by the doctor the doctor in this particular situation notwithstanding the patient specific presentation to him requesting medical advice specifically explained to her that i am not a treating physician she's here for an independent evaluation and i cannot give her medical advice there's no question that very often examining physicians almost always under section twelve become treating physicians but they cannot become treating physician us to circumstances obtain one is the choice which is the choice under section eight to treat with that position and the physicians consent to treat but if the physician is examining section twelve and makes a recommendation not a prescription a recommendation for a procedure whether diagnostic or invasive it is the on the commission's power to order that that occurs because it's not e it had attached there was a recommendation but not a prescription for a sick certain procedure that may aid in diagnosis and that the exam occurred under certain independent conditions for the purpose of determining the nature or probable duration of the condition and how much may or may not be owed under the act but a recommendation is not a prescription a value way why does he have to have it was because it's  because there is not a patient physician relationship that begins that requires two things it requires that it be sought out by the patient that occurs to cure and relieve under section eight and there must be consent by the evaluat not recommending a procedure ordered by the commission no no and i've been out of the sauce of legal research the question and kept the commission look at the record and see a recommendation from a medical person was an inquiry as to whether or not a prescribe lumbar surgery was incurred into the act because two physician had to treating physicians who treating physicians had prescribed the procedure post the word  herself then so i already started with her scrub in the plantation good morning that's right ok you don't have taishan limited to only prescribe you have there are there are no reported cases in which a we need a neural psychological evaluation and i'm not qualified to do it it's gotta be done for a day it should be done this is here and nineteen believe that sooner or later this commission is going to have to determine the full nature and extent of this means injury in order to determine the benefits he gets that's right your own expert says in order to do that i need a neural psychological test but he does so opining and recommending no which is not a prescription cannot be incurred under section eight as he's not sure you serious question share how much since you were a psychological examination caused perhaps about as much as we offered for the case w subtle but i don't know probably a thousand bucks a day as with this whole appeal is about but you hope he was not about this the whole appeal is about whether or not this particular test ordered by the commission a they were focusing on their interpretation of using the word occurred as a prescription from a doctor that they include a prescription for future medical and has medical treatment that has not yet incurred but the commission has right toward that prospective medical treatment interesting point here i want to put it in different focus it's your obligation to prove what the nature and extent of the claimants your injury is is not their obligation to assist you in doing  choices for treatment for psychological evaluation psychiatric evaluations neurological evaluations all of this treatment was denied so there are multiple recognition from our own treating physicians that will part of the initial trial in this case now the isn't there a potential for abuse here in this circumstance we were just saying you know the irony comes in and that makes an off the cuff recommendation that if you really want to know this is sort of making  they they said ok your triggers whatever reason let's look at an independent medical examiner because we think they're more credible they're not they're not purchased opinions ok but they probably ar as in i believe that they can if they are docking that physicians opinions in the context of a nineteen be hearing not to order treatment but to order an evaluation to determine what the nature and extent of the injury actually is in the case especially the  hearing for the one thousand me for future medical treatment but because nothing has been approved and in this case the petitioner wants to move forward that consultation it's not a situation where again with slippery source not really slow because you're saying ok i recognize counsel was a trial counsel but not all treatment was denied it simply is not accurate to state that all treatment was denied the other point i'd like to make on rebuttal is that there was no physician other than the section twelve examiner that specifically recommended a neuro psychological evaluation where you can see bill that there were recommendations for other types of back we have no question about it that was not were not excuse me awarded by the commission i point  conservative treatment some physical therapy can the commission not say we're going with the section twelve examiner we're going to order in a post spec deve physical therapy and so forth just like he recommend if a patient physician relationship has not obtained it can't or you're saying that we should not do that yes and i'd like to make it well i guess my point is that that kind of thing happens all the time well also the kind of thing that happens all the time is somewhere in between your two examples on conservative care let's say size injections into the spine which many consider to be invasive it could not be an order our argument goes because there's not a yes it what it was down to is the commission either agrees with the trader or not it's all or nothing on him follow up with the section twelve examiner why look at them and if he recommends some kind of future treat that it is argument under section eight and  like to just further ferret out a point bill on if the justices are more comfortable with what is a failure of proof relative to recommendations for specific psychological theory if you will the records pretty clear that very soon after let's call it the cutoff date of seven three two thousand and three there was a recommendation for psychological care by referral to a psychiatry that was not awarded by the commission the commission could have awarded that they could have looked at evaluation were ordered by the commission either on its own motion of course or that on on the motion allowed by one of the parties recognizing that would be both a valuations and claimant under the act can be examined examined and that's under section twelve or nineteen c section twelve actually read referencing one thousand see in the last sentence of the first paragraph of it the purpose of it is to  of course the commission's ability to decide disputed issues the commission could have were in one thousand see in the circumstance to clarify the let's call it for the throat of recommendation for a neuropsychological evaluation g in advance of that in connection with the hearing to order in their own motion impartial physical or mental examination if they want to and they can hear to believe anybody they want to  hundred ninety and in this particular case it occurs to me that ultimately they're going to get to decide the nature and extent of this means injury in order to determine whether the pain he claims he's suffering from is real or fa clear really wants the psychological evaluation if i may she didn't present herself to the section twelve examiner seeking medical advice that the examiner specifically declined to give her now relative your question in one thousand see how can the commission be aided by nineteen c in this circumstance the way they may be aided in this circumstance is twofold one they could all ward psychiatric care they declined to do so that's not before you she of course  well i think i've made that that are you but i do i do think that unless a patient physician relationship obtains the commission does not have the power to order prescribe here because it's not incurred under section eight