i rwirmzi t ] 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 1 of 57 PageID: 435
RaedGruuo 

15 Teth IIet Crie 

2s Floor, Suite 3 

Best 3reerbu,, New York 12051 

September 2, 2010 

Rich McDonald 

0/0 J&J Corporate Benefits 

410 George Street 

New Brunswick, NJ 08901 

RE: Johnson & Johnson Long Term Disability (LTD) Plan 

Employee: Ralph R Van Deventer Jr 

Case #: 74518 

WWID#: 

Final Level Appeal of Long Term Disability 

Date of Disability: 09/08/2008 

Benefits Denied Effective: 03/10/10 

Determination Due Date:10/13/10 

Dear Benefit Claim Committee: 

Enclosed you will find the final level appeal summary on Ralph R Van Deventer Jr’s claim. 

Once a final determination has been rendered, please send me a copy of the determination letter so 

that Ralph R Van Deventer Jr’s file can be updated and closed. 

Please feel free to contact me with any questions at 866-829-8861. 

Thank You, 

Natalie Madrid 

Reed Group 

Reed Group 110155 Westmoor Drivel suite 2101 Westminster, Colorado 80021 1800-347-74431303-247-18601 Fax 303-247-1863 

JJOOY 

Confidential 

Admin Rec. 0001 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 2 of 57 PageID: 436
Johnson and Johnson Short Term/Long Term Disability Appeal Summary 

Mme Ralph RYan Address, fTelephone: (732) 270-2897 

Deventer Jr 

rnre Date: 04/2411989 Age: 

Site: J&J - Absence ID: 74518 Workers Compensation: 

1200.120018.12ORB: no 

ORTHO-CLINICAL 

F DIAGNOSTICS-NJ 

_ 

Job Title: RTW: nla WW1D: 10900 

SR COMPLIANCE 

ANALYST 

FDA: 09/08/2008 Out Benefits Terminated: F ____ 09/08/2008-3/9/2010 03/10/2010 

Claim Type: LTD LTD effective date: Definition Change Date: 

Original Denial Letter: First Appeal Letter Date: Level 1 Denial Letter: 

L0z182010 _. 

06/30/2010 08/10/2010 

Second Appeal Letter 

Date: 08)27/2010 

 Reasmr(DeniaF Rationale) -- ------------------------------ -------- ----.- 

You were denied LTD benefits effective 03/10/10 as and ME has found the you capable 

of a sedentary work position. On appeal, the claim was sent for a physician file review 

Per physician file review: 

Clinical History 

The claimant is a Wear-old male with a history of chronic low back pain. The claimant 

reported an initial back injury in 1979. The claimant reported low back exacerbation in 

June of 2008. The medical record mentioned a left Achilles tendon injury in May 2008. 

Low back pain progressed to the extent that the claimant was unable to return back to 

work as of July 2009. He was seen by an orthopedic surgeon who prescribed him 

treatment including a course of physical therapy with modalities. Despite treatment, the 

pain did not subside. The claimant underwent an MRI scan of the lumbosacral spine 

which revealed diffuse facet degenerative changes. The claimant underwent epidural 

steroid injections as well as facet joint injections by his treating physician. In addition, the 

claimant has been subjected to chiropractic treatments and manipulations. 

Concomitantly, the claimant was seen by a psychiatrist at/east on one occasion on 

September 17, 2008. The claimant developed signs of depression and anxiety. Pain 

management specialist Dr. Carmen Quinones at the Pain Institute of New Jersey was 

providing ongoing pain management. A neuropsychological consultation was conducted 

on February 12, 2009 by Dr. Kutner which revealed a longstanding dysthymic disorder, 

exacerbated by ongoing pain and physical limitations stemming from the low back pain 

exacerbation. Neurocognitive impairments have not been severe as to restrict 

psychologically and cognitive incapacity preventing full day work. The claimant was able 

Last Revised 9/1812007 

Confidential 

Admin Rec. 0002 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 3 of 57 PageID: 437
to return to work on a part-time basis in March of 2009. He was able to switch into full 

time work on April 06, 2009 until July 21, 2009 with accommodations including 

alternation of sitting and standing. The claimant underwent functional capacity 

evaluations in July of 2009 and January of 2010 at Biokinetics where he was deemed 

capable of any sedentary occupation. An independent medical evaluation by Dr. Barr 

was conducted on January 27, 2010 and reported capability of employment to sedentary 

duty work only for eight hours a day with obligatory requirements to change positions 

frequently. A functional capacity assessment took place in June of 2010 by therapist, 

Ellen Radar Smith, OTR, where she opined that the claimant demonstrated lass than 

sedentary capacity and he cannot resume his longstanding career as a pharmaceutical 

compliance officer. The claimant’s condition has been thoroughly assessed in both 

standing and sitting positions. The functional capacity evaluation therapist demonstrated 

the claimant’s inability to perform sustained sitting during the day even with a short 

breaks to relieve the foot, lag, back and neck pain. The claimant has been denied longterm disability claim and the decision has been appealed by the claimant’s legal counsel. 

No. Based upon the objective medical information provided for review, there is not 

documented evidence of functional limitations that supports the inability to work. 

Functional capacity evaluation reports as well as IME evaluations demonstrated 

evidence of functional abilities to perform sedentary work with frequent change of 

position. 

The functional capacity evaluation on January 07, 2010 reported that the claimant mat 

essential postural and physical demands of his occupation for any sedentary occupation 

for an eight hour workday. On January 27, 2020, Dr. Barr opined that the claimant is 

cap tvworkonlv. ----------------------- 

Neurocognitive impairments have not been severe as to restrict psychologically and 

cognitive incapacity preventing full day work. 

The neuropsychological evaluation on February 12, 2009 by Dr. Kutner contains detailed 

information in reference to the cognitive status of the claimant. 

The employee is able to work at sedentary capacity in any occupation with restrictions 

permitting him to change positions every 30 to 45 minutes. There is no evidence in the 

records which can justify a reduction of the claimant’s ability to work on a full time basis 

at her job. However, a modified job may be warranted to decrease the chances for 

further exacerbation of low back pain. The most commonly mentioned occupational risk 

factor is lifting. 

(Klein BP, Jensen RC, Sanderson LM. Assessment of workers’ compensation claims for 

back strains/sprains J. Occup Med 1984;26 443-448) and physically heavy work 

specifically related to energy demand, frequency, duration of loading, and peak load ( 

Anderson GBJ Epidemiologic aspects on low back pain in industry Spine 1981;6;53-60). 

It is well known handling materials especially lifting associated with bending and twisting 

is the most common work injury associated with the back injuries (Bigos S., Spengler 

D.M., Martin NA., Zeh J., Fisher L., Nachemson A., Back injuries in industry, a 

retrospective studies of pre-employment related factors, Spine 1986 volll pages 252-

256). High incidents of low back pain have been identified with heavy demand jobs 

independent with the workers pre-job back strength (Mooney V. at. al. Relationship of 

Last Revised 9/18/2007 

Confidential 

Admin Rec. 0003 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 4 of 57 PageID: 438
lumbar strength in the shipyard workers to workplace injury claims, Spine 1996 voL21, 

2001-2005). The claimant is capable of sedentary capacity work and should limit lifting to 

within the requirements of sedentary work, (Please see below for the detailed description 

of sedentary work.) 

Assessment/Rationale 

In view of medical information it is imperative to refer for the definition of sedentary work 

which has been commonly accepted based on Dictionary of Occupational Titles 

(http://www.ccupationalinfo ,org/appendxC_1 html) Sedentary job entails exerting up to 10 

pounds (4.5 kg) of force occasionally (occasionally: activity or condition exists up to 113 

of the time) and/or a negligible amount of force frequently (frequently: activity or condition 

exists 1/3 to 2/3 of the time) or constantly (constantly: activity or condition exists 2/3 or 

more of the time) to lift, carry, push, pull, or otherwise move objects, including the human 

body. Sedentary work involves sitting most of the time, but may involve walking or 

standing for brief periods of time. Jobs are sedentary if walking and standing are required 

only occasionally and other sedentary criteria are met. 

The records do not provide compelling evidence which would restrict the claimant’s 

ability to sustain at least sedentary capacity work with lifting and carrying 10 pounds 

occasionally and possibly 10 pounds routinely, walking for two hours in eight-hour 

workday and sitting for six hours in an eight-hour workday with adequate breaks. He is 

able to sustain bimanual labor activity. Medical records do not indicate the claimant’s 

inability to ambulate functional distances on even and uneven surfaces, drive and 

negotiate stairs. His upper extremity activities are not restricted. The claimant can have a 

range of motion above the shoulder level for work-related activities. Medical records 

v.jIable for my review demonstr te positive MR1 findings of the lumbar seine which 

revealed productive changes which have been suggested as the source of the claimant’s 

pain; however, this may not necessarily be significant in this case due to the fact that 

many people without back pain have disk bulges or protrusions but not extrusions. In 

addition it should be pointed out that not all degenerative disc pathologies are painful. 

About 20% of asymptomatic controls under the age of 60 have been found to have 

herniated discs. 

(Boden et al. Abnormal Magnetic Resonance Scans of the Lumbar Spine in 

Asymptomatic Subjects: A Prospective Investigation JBJS 1990 vol.72 p403-408). 

However, due to the lack of response, the claimant have been consistently referred to 

mental health care professionals and non surgical options for treating his low back pain 

have been suggested. 

Reference: (Plan Language) 

Reed Group is the administrator for the Johnson & Johnson Long Term Disability (LTD) 

Plan. As of 3/9/2009, you will have been receiving LTD benefits from the Plan for the 

past twelve (12) months. Under the Plan, in order for your benefits to continue you must 

now meet the definition of being totally disabled from any occupation, which is defined 

by the Plan as follows: 

C. during the remainder, if any, of the period of disability, the complete 

inability of the Participant, due to Sickness or Injury, to perform any job 

for which the Participant is (or may reasonably become) with or without 

Last Revised 9118/2007 

Confidential 

Admin Rec. 0004 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 5 of 57 PageID: 439
reasonable accommodation qualified by training, education or 

experience. 

Diagnosis 

Degeneration of Thoracic or Lumbar Intervertebral Disc 

Lumbosacral Spondylosis without Myelopathy; Arthritis; Osteoarthritis; Spondylarthritis 

Sprains and Strains of Other and Unspecified Parts of Back, Lumbar Spine 

Tenosynovitis of Foot and Ankle 

Dysthymic Disorder; Anxiety Depression, Depression with Anxiety, Depressive 

Reaction, Neurotic Depressive State, Reactive Depression 

Cervical Inter-vertebral Disc Displacement without Myelopathy; Neuritis (Brachial) or 

Radiculitis Due to Displacement of Cervical Intervertebral Disc 

Cervical Spondylosis with Myelopathy; Anterior Spinal Artery Compression Syndrome; 

Spondylogenic Compression of Cervical Spinal Cord; Vertebral Artery Compression 

Syndrome 

Facts 

See denial rationale. 

MIJA. Guidelines 

Degeneration of Thoracic or Lumbar Intervertebral Disc 

Medical treatment, lumbar intervertebral disc degeneration. 

DURATION IN DAYS 

Job Minimum Optimum Maximum Classification 

Sedentary 0 14 21 

Light 0 14 28 

Medium 0 28 42 

Heavy 0 42 84 

Very Heavy 0 42 84 

Lumbosacral Spondylosis without Myeiopathy; Arthritis; Osteoarthritis; Spondylarthritis 

No duration listed. 

Sprains and Strains of Other and Unspecified Parts of Back, Lumbar Spine 

Supportive treatment, lumbar or lumbosacral spine sprain or strain. 

DURATION IN DAYS 

Last Revised 9/18/2007 

Confidential 

Admin Rec. 0005 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 6 of 57 PageID: 440
Job 

Classification Minimum Optimum Maximum 

Sedentary 1 3 7 

Light 1 7 14 

Medium 3 14 28 

Heavy 7 21 42 

Very Heavy 7 28 56 

Tenosynovitis of Foot and Ankle 

Medical treatment, tenosynovitis. 

DURATION IN DAYS 

Job Minimum Optimum Maximum Classification 

Sedentary 1 3 7 

Light 1 7 14 

Medium 3 14 28 

Heavy 3 21 56 

Very Heavy 3 28 56 

Dysthyrnic Disorder; Anxiety Depression, Depression with Anxiety, Depressive 

Reaction, Neurotic Depressive State, Reactive Depression 

Psychotherapy and/or pharmacotherapy, dysthymic disorder. 

DURATION IN DAYS 

Job Minimum Optimum Maximum Classification. 

Any Work 1 14 28 

Cervical intervertebral Disc Displacement without Myeiopathy; Neuritis (Brachial) or 

Radiculitis Due to Displacement of Cervical Intervertebral Disc 

Medical treatment, cervical disc displacement. 

DURATION IN DAYS 

Job Minimum Optimum Maximum Classification 

Sedentary 0 7 21 

Light 0 14 28 

Medium 0 21 42 

Heavy 0 49 84 

Very Heavy 0 56 90 

Cervical Spondylosis with Mydlopathy; Anterior Spinal Artery Compression Syndrome; 

Spondylogenic Compression of Cervical Spinal Cord; Vertebral Artery Compression 

Syndrome 

No duration listed. 

Last Revised 9/18/2007 

Confidential 

Admin Rec. 0006 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 7 of 57 PageID: 441
Last Revised 9/1 8/2007 

Confidential 

Admin Rec. 0007 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 8 of 57 PageID: 442
Absence Report - Van Deventer Jr, Ralph R 

01-Sep-10 

Employee Name Van Deventerir Ralph R 

Social Security U 

Address 40& 

Home Phone 

DOE/Age 

Gender 

Employer J&J -6l18.U312.62170: ProductCornpliance 

Group J&J 

Department 

Shift 

Job/JobTitle Sr Compliance Analyst 

Supervisor Rosado, Jose L 

Exempt Yes 

Hire Date 412411989 

Termination Date 311112010 

Job Class Medium 

*Employment information is as of the Open Date of the Absence. 

Absence ID 74510 

AbsenceType Disability 

Current Program LTD 

Date Received 9/912008 

Lost Time Start Date 9/8/2008 

Lost Time End Date 3/912010 

Calendar Days Lost 548 

Lost Work Days 304 

RTW Date 

0 

0 

0 

Employee Number: 10900 H 

Job Status Active 

Hours per Week 40 

Base Pay $78,800.00 

Base Pay Period Annual 

Other Pay 

Other Pay Type 

Other Pay Period 

Union Name 

Union Local 

Work State NJ 

Page 1 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 9 of 57 PageID: 443
Disability Start Date 902008 

Disability End Date 3/812010 

Disability Calendar Days 547 

Disability Work Days 302.5 

Primary Diagnosis 722.5 Degeneration of ThoraciG or Lumbar Intervertebral Disc 

MDA Guidelines Minimum 0 Days Optimum 28 Days Maximum 42 Days 

Primary Physician Strauss, Irving (Dr.) 

Incident Date 

incidentDescription 

PrognosisDate 

Prognosis Days 0 

MDA Max Days -616 

MDA Max RTW Date 12/24/2008 

0) 

0 

0 

0 

ma 

’0 C 

0’D 

MCA 

Claim Number 

CaseNuniber 

Insurance Carrier 

Policy Number 

Definition Change Date 

Name Primary Contact Diagn Treatni Degree Spec 

Strouse. Irving (Dr.) Yes Yes Yes Yes MD ORS 

 Business 2lO 3rd Avenue SuIteSO4 Yes 

Long Bmnth, NJ 07740 

-r 

8usinezs 

Fax 732-571-1937 

Email Address Web Site 

Page 2 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 10 of 57 PageID: 444
Name Primary Contact Diagn Treater Degree Sp 

Barr, Lawrence I. (Dr) Yes Yes MD OF 

Tfl7ng 455 Route 70 West No 

Cherry Hill, NJ 08002 

Business 3535 Ouakerbridge Road, Suite 200 No 

Hamilton, NJ 08690 

Business Garden State Orthopedics No 

300 Water Street 

Toms River, NJ 08753 

Business 2 455 Marlton Pike West Yes 

Cherry Hill, NJ 08002 

rr 

Business (856) 616-2999 ECN provider 

Business Fax (856) 616-1437 

Basin, Stephen ft Yes 

Email Address Web Site 

0 

’C 

0 

0 

ma 

-o C 

9- cE 

0’a 

0< 

70 Grand Avenue 

River Edge, NJ 01681 

Business 201-142-4117 

Business Fax 201-342-8780 

Cavanaugh, Colleen (Dr) Yes MD PSYC 

Business 1541 Route NB West, Ste. J Yes 

Rdcktnwn, NJ 08724 

Business (732) 202-0622 

Business Fax (732) 202-0620 

Page 3of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 11 of 57 PageID: 445
Name Primary Contact Diego Treatm Degree Spec alty Email Address 

Filippone, Charles Yes Yes PT PT 

Business fl7okinel7cs Yes 

Hadley Medical Building 

1080 Stelton Road, Suite 204 

Piscataway, NJ 08854 

Business Cooper Rehab & Sports Therapy No 

315 Route 35 North 

Red Bank, NJ 07701 

Business 2 Biokinetics No 

The Center Circle 

1255 Main Street 

Rahway, NJ 07065 

(72 741 -50!5 ECN Provider 

Web Site 

r 

r 

0 

0 

0) 

-o C 

0 -c 

0cc 

Graves, Denise Yes i dgravesocdus.jnj.com 

Eligibility Fax (908) 218-4611 

Eligibility Work (008) 704-3887 

Page 4 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 12 of 57 PageID: 446
Name Primary Contact Diagn Treatrn Degree Specialty Email Address Web Site 

Heyman, Norman (Dr.) Yes MD ORS 

rn 

UusIness 245 Union Avenue, nTte 1-A Yes 

Bridgewater, NJ 08807 

Business 256 Old Nyack Turnpike No 

Spring Valley, NY 10977 

Business Office Of Dr. Amato No 

75 New Brunswick Avenue 

Hopelawn, NJ 08861 

Business Office Of Marshall Chiropractic No 

1187 Main Avenue, Suite 3-0 

Clifton, NJ 07011 

Business Office Of Marshall Chiropractic No 

1195 Main Avenue (Front Store Office) 

Clifton, NJ 07011 F 

Business Offices Of IRS No 

44 East 32nd Street, 11th Floor 

New York, NY 10016 

Business 2 Office Of Dr. Glassman - No 

110-27 Queens Boulevard (72nd Blvd.) 

Forest Hills, NY 11375 

at 

Business (908) 526-2889 ECN Provider 

Kutner, Kenneth (Dr.) Yes PhD NPS 

Ru!ness 211 Essex street No 

Suite 405 

Hackensack, NJ 07601 

 Business 3000 Atrium Way, Suite 100 No 

Mount Laurel, NJ 00054 

Business 440 Curry Avenue, Suite B No 

 Englewood, NJ 07631 

Business Bergen Neuropsychology Group Yes 

339 Princeton Hightstown Road 

4-O) 

-o C 

0cC 

Page 5 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 13 of 57 PageID: 447
Name Primary Contact Diagn Treatm Degree Spec alty Email Address Web Site 

Pericone, Anne Yes APERICO@ITS.JNJ.COM 

r??gIbfly Wmlc (X7fl 541-25 

Quinones Carmen M. (Dr.) Yes Yes MD Pain 

Business 254 Brick Blvd., SuIte 2 Yes 

Brick, NJ 08274 

flusiness (732) 477-4242 

Business Fax (732) 477-4368 

Vaccaro, Yes 

I kvaccarO@ocdus.jnj.com 

Kathryn 

Business (9O) 21-UM 

Eligibility Fax (908) 218-8484 

Date Diagnosis - Minimum Optimum Maximum ’hysician Notes 

9/812008 7213 Lumbosacral Spondylosis without btrouse, Irving (Dr.) Going to PT 3x week for three weeks and then will be 

Myelopathy; Arthritis; Osteoadhritis; , reevaluated on 1011. 

Spondylarthritis 

91812008 847.2 Sprains and Strains of Other and 3 14 28 i htrouse, Irving (Dr.) 

Unspecified Parts of Back, Lumbar Spine 

91812008 727.06 Tenosynovitis of Foot and Ankle 3 14 28 

1 Shouse, Irving (Dr.) wearing cam hoot. 

911712008 300.4 Dysthymic Disorder; Anxiety Depression, I 14 25 

Depression with Anxiety, Depressive Reaction, I 

Neurotic Depressive State, Reactive Depression 

11/1312008 722.5 Degeneration of Thoracic or Lumbar 0 28 42 ttrouse, Irving (Dr.) 

Intervertebral Disc 

611712009 722.0 Cervical Intervertebral Disc Displacement 0 21 42 

without Myelopathy; Neuritis (Brachial) or 

Radiculitis Due to Displacement of Cervical 

Intervertebral Disc 

Page 6of 105 

03o 

0) 

’0 C 

cE 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 14 of 57 PageID: 448
I-,’ 

Notes 

Notes 

COo 

4 a) 

jo 

iZ7 C 

’tEE 

0< 

Status Admitted Discharged Notes 

Scheduled 

Scheduled 

Scheduled 

Scheduled 

Scheduled 

Completed 

Scheduled 

Completed 

Completed 

Completed 

Completed 

Scheduled 

Completed 

PCP 

MR1 

STD Bucket 

$750 no-show/cancel within 48 

hours. LTD Choices 60% 

I Minimum Optimum Maximum 

6117/2009 721.1 Cervical Spondylosis with Myelopathy; 

Anterior Spinal Artery Compression Syndrome; 

Spondyiogenic Compression of Cervical Spinal 

Cord; Vertebral Artery Compression Syndrome 

Date Entered! Prognosis Date Changed By Explanation 

Changed 

9/1112008 10/612008 CTeta Initial Prognosis 

1013/2008 10/27/20W) CTeta Extension Requested 

1012412008 11117/2008 CTeta Extension Requested 

11114/2008 12/1/2008 CTeta Extension Requested 

1112612008 1212912008 CTeta Extension Requested 

12/26/2008 1/29/2009 CTeta Extension Requested 

1/2712009 312/2009 Cleta Extension Requested 

1127/2009 3/312009 CTeta Extension Requested 

2119/2009 31912009 CTeta Extension Requested 

2/2412009 4/6/2009 CTeta Full Duty 

In.- MVpltlr-a Description 

918/2008 Strouse, [wing (Dr.) Last Date of Treatment 

9/11/2008 Physical Therapy 

9112/2008 Office Visit 

10/17/2008 Strouse, Irving (Dr.) Office Visit Scheduled 

1111012008 Strouse, living (Dr.) Office Visit Scheduled 

11/13/2008 Diagnostic Testing 

11/2412008 Strouse, Irving (Dr.) Office Visit Scheduled 

1/13/2009 Heyman, Norman (Dr.) IME 

1/26/2009 Quinones, Carmen M. ( Procedure 

2/912009 Quinones, Carmen M. ( Procedure 

211212009 Kutner, Kenneth (Dr.) ME 

31312009 Strouse, Irving (Dr.) Office Visit 

7/2312009 Filippone, Charles FCE 

Page 7 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 15 of 57 PageID: 449
I rearmenrs & II 

In. JflPflTfll 

rtl’Ji 

Agency/Hospital Description Status Admitted Discharged Notes 

It) 

0 

0 

712912009 Barr, Lawrence I. (Dr.) ME Completed Ortho ME 

11712010 Filippone, Charles FCE Completed LTD Choices 60% 

112712010 Barr, Lawrence I. (Dr.) ME Completed LTD Choices O% 

I7t17TW1lriiw 

Restriction Limitation indefinite Starting Ending Physiclah Notes 

Lifting 10 lbs No 3/212009 41612009 Strouse, wing (Dr.) 

Standing intermittent No 3/212009 41612009 Strouse, living (Dr.) 

Climbing None No 3/212009 4/6/2009 Strouse, wing (Dr.) 

Push/Pulling No 31212009 4/6/2009 Strouse, wing (Dr.) 

Twisting Occasional No 312/2009 4/6/2009 Strouse, Irving (Dr.) 

Squatting Occasional No 312/2009 4/6/2009 Strouse, Irving (Dr.) 

FMLA Start Date 918/2008 

FMLA End Date 11/30/2008 

Type Status From Thru Days Authorized By E Entered Entered By Notes 

0)0 

13) 

’13 C 

cE 

4’ 

Disability Duration Approved 9/812008 10/5/2008 28 Cleta d/l8/2008 CTeta 

FMLA Approved 9/8/2008 10/512008 28 CTeta 4/18/2008 CTeta 

Disability Duration Approved 10/6/2008 10126/2008 21 CTeta 0/6/2008 CTeta 

FMLA Approved 10/612008 10/26/2008 21 CTeta 10/612008 CTeta 

Disability Duration Approved 10/27/2008 1111612008 21 CTeta 11 0124/2008 CTeta 

FML.A Approved 10/27/2008 1111612008 21 CTeta 10/24/2008 CTeta 

Disability Duration Approved 11117/2008 1113012008 14 CTeta 11/18/2006 CTeta 

FMLA Approved 11/17/2008 1113012008 14 Cleta 1 1 /1812008 CTeta 

Disability Duration Approved 12/112008 12/1212008 12 CTeta 11/2612008 CFeta 

Disability Duration Approved 12113/2008 12/28/2008 16 CTeta 2/812008 CTeta 

Disability Duration Approved 12/29/2008 1/28/2009 31 CTeta iziZolzuMo CTeta 

Disability Duration Approved 1/29/2009 31112009 32 CTeta x /27/2009 C eta 

Modified Work Approved 31212009 318/2009 7 CTeta 2/2712009 G eta 

Modified Work Approved 319/2009 41512009 28 sterry j /5/2009 sler 

LTD Approved 712112009 8/31/2009 42 starry 7/2212009 sterry 

Page 8 of 105 

Pending IME and LDOT 1120109 

working 4 hours a day 

LTD elf PD planned 4/609 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 16 of 57 PageID: 450
J3 C) 

-LW 

’0 C 

’I-- cE 

0 -a 

o.c: 

2 

Type Status From Thru Days Authorized By Date Entered Entered By Notes 

LTD Approved 9/112009 1173012009 91 sterry 812012009 stony 

LI I_I fl}iIUVCU IC! IIZ_UUU .JIUIC_U ’U OU LI_ILIII’ rIIUI_IJ Ill 

LTD Approved 3/9/2009 41512009 28 mwadsworth 5’19/2010 mwadsworth correction 

LTD Denied 4/612009 712012009 lOG mwadsworth 5219/2010 mwadsworth correction 

LTD Denied 319/2010 319/2010 I rnwadsworth 5f1912010 rnwadsworth denial upheld on appeal 

WflThta.L.mlinRecorn. Start Work Program Start Date End Date Reason Ended Los Time Restricted Notes 

212/2009 Part Time 00 No 

312/2009 Part time 3/2/2009 3/0/2009 Progression to other MW 00 Yes 

program 

31912009 Pad Time 3/912009 4/5/2009 Employee Disabled 00 Yes 

4/6/2009 Full Time - 416/2009 7120/2009 Employee Disabled 00 No 

Name Type Job Title Department Email Address Web Site 

Graves Denise Employer Contact Eligibility 05/2912007 dgravesocdus.jnj.com 

flglbllffy Fax (9fl8 21-411 

Eligibility Work (908) 704-3887 

Vaccaro, Employer Contact Eligibility 01-IN 41212006 kvaccaro@ocdus.jnj.com 

Kathryn 

nis1ness U) 218-8070 

Eligibility Fax (908) 218-8484 I 

PeniconØ Anne Employer Contact APERICO@ITSJNJ.COM 

- 

ibility Work (900) 541-5825 

Penicorie, Anne Employer Contact APERICO@ITS.JNJ.COM 

rttgrolmywork ona 541-5825 

Page 9of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 17 of 57 PageID: 451
Bosin, Stephen R. Contact 

en 

Business 70 Grand Avenue 

RPs’er Edge, NJ 07661 

S i4f 

Business 201-342-4117 

Business Fax 201-342-8780 

4!fl7[4t 

Date Due Date Compltd Type Case Manager 

Notes 

0 C 

Yes 

Person Contacted Event Description Reference To 

Name Type Job Title Department Email Address Web Site AS 

91112010 Task Nanovich, Diane I Case Review Case Information 

NMadnd -Appeal Specialist - 813112010 please print file and make one copy for 2nd level appeal 

91112010 Task Madrid, Natalie Case Review Appeal Brief 

NMadrid -Appeal Specialist - 813112010 create 2nd level appeal brief and send file to CAFS and J&J CB 

10113/2010 Task Madrid, Natalie Case Review Appeal Decision Due 

NMadrid -Appeal Specialist - 8/31/2010 determination due 1011 3/10 

9/9/2008 91912008 Phone Call zzl-laverly, Cindy Spoke to Case Intake 

Recvd call from EE to open STD Case Lumbar spine osteo arthritis and left ankle tenosynovitis.LDOE 9/5/2008. FDA 9/8/2008. LDOT 91812008, NDOT unknown.ExpI PPW and Transfer to NCM. 

Works 6:00-2:00, 40 Hrs wk, 

9/9/2008 9/9/2008 Mail Merge zzHaverly, Cindy Rosado, Jose L Employer Notification Job Analysis Request 

Job Analysis Request - Job Analysis Needed 

Page 

NO 

9/912008 91912008 Mail Merge zzHaverly, Cindy Rosado, ,lose L Employer Notification FMLA Eligibility Request 

FMLA Eligibility Request 

91912008 Mail Merge Gibson, Heather Employer Notification Initial 01-IN Contact 

9/2312008 9110/2008 Task zzTeta, Cristina Case Review Determination - Initial 

Initial Determination (10 Bus. Days)-med rec. 9110 

9/10/2008 9/10/2008 Task zzTeta, Cristina Strouse, Irving (Dr.) Provider Contact Initial Provider Contact - 1st 

attempt 

1 st.Day ProviderContact 

9110/2008 9110/2008 Task Wheeler, Judy Employee Contact Initial Assessment - 1st attempt 

Call ee [NJ]- do intro 

9110/2008 911012008 Phone Call Wheeler, Judy Message Received Case Information 

EE left message for call back and confirmed contact /t. 

9/1012008 Mail Merge Gibson, Heather Forms STD Packet 

STD-FMLA Introduction Packet.doc 

9/10/2008 9110/2008 Phone Call zzTeta, Cristina Strauss, Irving (Dr.) i Provider Contact Complete Medical - Initial 

9110 cmt. Spoke to Lynne at doctors office. Confirmed Lumbar Spine Osteoarthritis and L ankle sprain (tnosynovitis). EE is using a cam walker, going to PT. Has flu in three weeks which is not yet 

- scheduled. Dr. has cc now at least until f/u. 

10 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 18 of 57 PageID: 452
cc 

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Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

9/10/2003 9/1012008 Phone Call Wheeler Judy Message Received Case Information 

EE left messaqe requestino call back and confirmed contact #. I OD 

0 cc 9/10/2003 9110/2008 Phone Call Wheeler Judy 

INTRODUCTION: Spoke to employee: completed the introduction to Reed Group; case managen 

time Choices eligible employees) and Local 630 full and part-time employees, and RI state disabif 

As your nurse case manager, I will be responsible for evaluating your disability claim and deter 

with information that will assist you to understand your diagnosis and to make important decisions 

MANDATE ANY TREATMENT, AS THIS IS THE RESPONSIBILITY OF YOUR PHYSICIAN OR F 

provider(s) to develop a case management and return to work plan that will be specific to your nee 

notifying your employer of your request for absence. I will not be discussing your medical informa 

information is strictly confidential and will only be shared with the J&J OHN as needed and to cool 

Manager from the Reed Group will be contacting them in the next few days to obtain medical infor 

YOU may be eligible for FMLA for this leave as well. If you meet the requirements, your FMLA will 

decision. 

You must meet the required seven (7) day elimination period prior to any authorization being s 

be effective from the first date of your medical absence. Your STD wages will be based on your yr 

Initial Clinical Review Initial Assessment - 1st attempt 

process reviewed; verbal permission to case manage obtained. Advised of CA, NY, NJ (part 

Wing requirements. OA Verbal permission obtained.jw 

ing your eligibility for the .1&J Short Term Disability program benefits. I will work to provide you 

arding treatment PLANS and to facilitate the RTW process. I DO NOT PRESCRIBE OR 

LTH CARE PROVIDER. I WILL WORK WITH YOU and your physician or health care 

Your plan will be continuously evaluated for effectiveness and revised as needed. I will be 

with your Supervisor, only the fact that your have reported your disability. Your medical 

As your RTW plan. Please inform your physician or health care provider that a Nurse Case 

ion regarding your diagnosis, treatment and RTW plan. As reminder, please be advised that 

concurrent with your Shod Term Disability Leave arid you will be notified in writing of the 

i J&J Payroll for payment of short-term disability benefits. Approval for the STD absence will 

of service with J&J. NOTE: Union employees are paid a negotiated rate. 

**Reed Group will make three (3) attempts to contact your physician over the next ten (10) business days to obtain medical information to support your absence. If unable to obtain the 

information by the tenth (10th) business day, your absence will he identified as STD pending which neans that your pay will be discontinued until the information is obtained. If the medical 

inrormationldocumentation is not received within thirty (30) days, your request for medical leave will J1 

I 

e DENIED.** You will kept informed in writing of all approvals of disability duration, as well as 

any denials that may occur, the reasons for any denials, and the process for you to appeal any deniadecision. 

**Should you require an extension of the original approved leave time, or if you will not return to 

and/or your health care provider submits supporting objective medical documentation to Reed Cr 

documentation are 

 Physician office/progress notes 

 Diagnostic Test Results (X-rays, MRI, etc.) 

 Laboratory Results 

 Physical Therapy notes 

If you are returning to work on or before the end of the authorization period noted above, you will 

care provider prior to the last authorized date of disability.** If you have any questions, concerns, 

contact your Nurse Case Manager, LCT_J at (866) 829-8861, extension 8692 - We 

WORK SCHEDULE 

State EE works in: NJ 

Job title and job physical demands:ear special shoes?) Senior Compliance analyst. Desk work. 

Shift/hours worked: 6a-2p M-F 

Do you drive a company vehicle? no 

LDW: 9/5/08 

FDA (disability/treatment): 918/08 

DISABILITY CASE INFORMATION 

FDOT: ongoing-ce has been procrastinating and it has gotten worse-ce has seen PCP and chiro 

functions. Saw Ortho MD on 0/8/08. MD rx’d ee for PT 3 x week for back. 

NDOT: to beset up ifj 1011 pending outcome of PT. EE in air cast for achilles 

Provider/ Specialty (confirm contact information): Verified MD info 

Page 11 of 105 

or before the end of the authorization period, it is your responsibility to ensure that you 

(5) days prior to the last authorized date of disability. A few examples of this 

to provide Reed Group with written documentation of your Release to Work from your health 

alaints, or would like additional information regarding case management services, please 

onward to working with you. 

it got to be too much. EE’s back and leg are not conclusive to ee being able to perform his job 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 19 of 57 PageID: 453
een PCP and Chiro and it got to be too much. EE saw Ortho MD 9/8/08 and was RX’d for PT 

novitis is TX with CAM boot, EE trying not to aggravate the conditions worse than they 

e to relay that info to MD as ee has a lot of personal issues on his plate also as his mom 

helpful and Ce will discuss w/MD at NDOT 9/12108. EE’s house is set up to accommodate 

Event Description Reference To 

0) 

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0 

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C) cc 

Kaiser Medical Record #: NO 

Diagnosis/Illness (specify which side of body if applicable, e.g. Right Arm) 

EE OOW nit ongoing issues of procrastinating regarding TX and pain and it has gotten worse. EE had 

3 x week for his bad. Rack has lumbar strain/sprain and lumbosacral spopndylosis. His (L) ankle too 

already are. PT starting tomorrow and sees PCP 9/12/08. EE getting discouraged and Nurse advised 

was just admitted to the Hosp. for a stroke. EE taking Flexoril and Naprosen which ee states is not to 

his needs and he is staying on the first floor. Triage Nurse entered DX codes per ppw ee had from Ml 

PREGNANCY CASES 

Date Due Date Cornpltd Type Case Manager Person Contacted 

Notes 

NOTE: Remind EE at this time, that they must have their post-partum examination by the end of the 6th week after delivery 

Work related? Yes.. ...... No .. XX. ..Possible? OHN must be notified of any potential W/C claims. 

Mechanism of Injury: How did injury occur? Enter data here and on the Illness/Injury Tab in MDA: 

List one of the following: 

A. Motor Vehicle Accident 

B. Motorcycle/ScooterAccident 

C. Bicycle Accident 

D. Slip, Trip, Fall 

E. Lifting at home 

F. Bending 

G. Pushing, Pulling 

H. Exercising 

I. Aggravation of prior back problems 

.1 Other (please specify) 

If Mental Health condition what was the precipitating event? (e.g. Divorce, death of family member) 

Have you utilized EAP services for this problem? n/a 

Current Treatment plan (diagnostic tests/surgery and their dates):Take read pm, PT as 

Anticipated 00W duration: unknown-possibly 10/6108. Reviewed RTW process 

1-lospitalization: Yes. .... NoXX Admission Date: Discharge Date: 

PAST MEDICAL/SURGICAL HISTORY: Co-morbids? Knee surgery 2005. Slight sleep apnea, but 

PAST MENTAL HEALTH HISTORY: Prior treatment or hospitalization? When? ri/a 

keep MD appls. 

Medications: Naprosyn, flexoril 

Allergies: no 

Smoking Hx: never 

Alcohol/Drug Hg: no 

Height: 6’ 

Weight: 205 

Right/Left hand dominant: n/a 

Second job or hobbies that may impact upon recovery: no 

Current ADtJPhysical activity level (including sports): EE able to take care of self-ce has assistance pvailable as wife is home during the day. 

Safety concerns: No per ee-ee to discuss pain med mgmt w/MD 9/12108 as pain med is not very effective for ee. We reviewed pain med mgmt, s/e and maintaining safety. EE’s home has been 

set up to accommodate Ce’s needs and he is staying on the first floor. EE compliant w/MD recommentlations. EE aware of RTW process. EE has assistance available as needed as wife stays 

home to care for children. - 

Elder/Child care responsibilities: 4, 6 and B yo-wife is taking care of care 

Discussed with the employee the need to return the signed Authorization and Reimbursement Agreer4ent to Reed as soon as possible. Return to work/restriction process. The need to update 

Reed with any changes in their care or condition. Telephone and fax contact numbers for Reed confirmed. 

Page 12 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 20 of 57 PageID: 454
Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

9110/2008 9/10/2008 Case Notes Wheeler, Judy 

Care/Case Management Plan 2: Low Back Injury/Disease and ankle disorder 

Referral triggers: 

9/10/08-EE now rift ongoing issues of procrastinating regarding D( and pain and it has gotten worse. 

RXd for PT 3 x week for his back. Back has lumbar strain/sprain and lumbosacral spopndylosis. His I 

than they already are. PT starting tomorrow and sees PCP 9112108. EE getting discouraged and Nurs 

mom was just admitted to the Hosp. for a stroke. EE taking Flexoril and Naprosen which an states is 

accommodate his needs and he is staying on the first floor.jw 9110/ 

ankle sprain (tnosynovitis). EE is using a cam walker, going to PT. Has flu in three weeks which is no 

f/ti.jw 

Case Review/CM Plan Care Plan - Back Pain 

E had seen PCP and Chiro and it got to be too much. EE saw Ortho MD 9/8108 and was 

ankle Inosynovitis is TX with CAM boot. EE trying not to aggravate the conditions worse 

advised as to relay that info to MD as ee has a lot of personal issues on his plate also as his 

at too helpful and an will discuss w/MD at NDOT 9/12108. EE’s house is set up to 

8-9/10 cmt. Spoke to Lynne at doctors office. Confirmed Lumbar Spine Osteoarthritis and L 

yet scheduled. Dr. has cc now at least until 

(no O) 

D = 

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OD 

0< 

Problem #1: Employee is not achieving optimal health due to alteration in comfort: Pain 

Short Term Goal: Employee will report a decrease in discomfort from initial assessment and a plan will be established to address needs. Within three days of employee contacts/1 0/O8jw 

Long Term Coal: 

Employee will return to pie-injury/illness pain free state within projected MDA guidelines. 

Interventions for short term goals: 

oEducate the employee on possible complications and elimination of factors that precipitate pain.9108jw 

17]Teach employee methods to reduce pain before it becomes too severe both pharmacological and non pharmacological methods for reducing pain/promoting comfort: back rubs, slow rhythmic 

breathing, repositioning, and divisional activities. I 

llConlact the employees physician to confirm the treatment plan, diagnoses, expected recovery time and expected MMI.9110/O8CT 

-DFollow up call to member at defined interval.ongoing 

[IListen to employee in a non judgmental manners/1 0/OOjw 

[Ildentify barriers.9/10/08jw 

DOffer assistance and support.9110/08jw 

Interventions for long term goals: 

oReview individual plan of action with the employee.9110108jw 

[]Assess employee has made the needed changes in his/her medical treatment influencing disability duration. 

l]Assessment of functional ability/attainment of maximal functional ability. 

DTimely return to normal activities and employment. 

flAppropriate utilization of resources 

DAvoidance of unnecessary surgery, hospitalization, treatment and imaging studies. 

Dlnstruclion on prevention of re-injury and decreased disability F 

tlProvide knowledge on provision of quality, cost effective care 

llEnsure employee has a plan in place to address barriers.9110108jw 

CReview individual plan of action with the employee and document in a written plan any accommodations designed to promote timely and safe transition back to full work productivity. 

Problem #2: Employee is not achieving optimal health due to alteration in physical activity and mobility to move purposefully within the environment. 

Short Term Coal: 

I .CEmployee will be knowledgeable of safety related issues due to activity limitations within three das of employee contacts/1 0108jw 

2.0Employee will demonstrate increased mobility/activity utilizing appropriate OME equipment within one week of injury/illness. 

Long Term Coal: 

Employee will progress to the highest level of mobility possible within limitations of diagnoses per MDA guidelines. 

Page 13 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 21 of 57 PageID: 455
Date Due Date Cornpltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

Interventions for short term goals: 

’[IEmployee will reduce or eliminate contributing factors by assess employees schedule. Allow rest 

UAssist to identify safety hazards in members environment or daily routineS/i OIOfljw 

UEncourage person to note daily progress. 

UEvaluate employees strength and degree of mobility through office notes or physical therapy note 

’[]Work with Physical therapist to obtain current treatment plan 

riEvaluate for proper use of function and adaptive equipment.911 0108jw 

UEvaluate proper referral to PlOT, or other 

DEncourage relaxation training 

Interventions for long term goals: 

uAssess employee has made the needed changes in his/her medical treatment influencing 

llAssessment of functional ability/attainment of maximal functional ability. 

4iTimely return to normal activities and employment. 

DPlan and share necessity of learning outcomes with the employee. 

-DAppropriale utilization of resources 

[]Avoidance of unnecessary surgery, hospitalization, treatment and imaging studies. 

fllnstruction on prevention of re-injury and decreased disability 

’liPrevention of possible complications 

DEnsure employee has a plan in place to address barriers. 

’UTo achieve consistent, quality care by using nationally recognized clinical guidelines. 

Criteria for Case management closure 

’r.]Functional improvement 

DRelief / reduction of pain and symptoms 

’liAØpropriate utilization of resources and benefits 

oAvoidance of unnecessary surgery, hospitalization and surgery 

C]Empfoyee satisfaction with medical care, case management services. 

’DEarly return to work 

DSafety issues have been identified 

flMedically cleared to return to work 

Case Management Resources: - 

C 

http://www.highbeam.com/library/ 

http://wyzw.americanhealthways.com/regence/CBP/Member/02.asp?Clnt=OO1 &Prog=CBP&Cat=Mh 

Aetna low back manual 

Conte L, Timir £3, The rehabilitation of persons with low back pain. Journal of Rehabiliation, April, I 

The Medical Disability Advisor, Presley Reed, MD Fourth Edition 

http://www.rncbntrat.com/careplans/plans/ai.hImI 

Praemer, A, Furner, 5, Rice, D, Musculoskeletal Conditions in the United States, 1992, American! 

Taylor V Deyo R, Cherkin D, Kreeulter W. Freidlieh 0, The impact of managed care on the diagno 

.! c 

between all activities. 0 C 

L!a 

duration. 

of Orthopedic Surgeons. 

and treatment of low back pain: a preimiary report. American Journal of Medical Quality 

Page 14 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 22 of 57 PageID: 456
ON a

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Date Due Date Conipltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

911012008 9110/2008 Phone Call zzTeta, Cristina Message Received Case Follow -Up 

9110 cunt. EE left message for call back to discuss diagnosis and PT info and possibly working from home, 

9/11/2008 9/11/2008 Task zzJackson Latonya Case Review Job Analysis Request 

1st request look for response 

9/16/2008 911112008 Task zzTeta, Cristina Strouse, Irving (Dr.) Provider Contact initial Provider Contact - 2nd 

attempt 

4th Work Jay Provider Contact-med rec 9/10 

9/1 8/2008 9111/2008 Task zzTeta, Cristina Strouse, Irving (Dr.) Provider Contact Initial Provider Contact - Jul 

attempt 

7th Work Day Provider Contpct-med. Rea 9/10 

9/11/2008 9/1112008 Phone Call zzTeta, Cristina Employee Contact Case Follow-Up 

9/I1 cad. EE called in with updale. He will be going to PT 3x per week. Saw ortho on 918. Wants to try and work from home a couple of hours per week, but says supervisor is not sure about that. 

EE will fax ppw from doctor to NCM with request to work from home. 

9/1812008 9/1212008 Task zzJackson, Latonya Case Review Job Analysis 

2nd requestreturntowellness 2nd request. Please complete attached 

Job analysis form. 

From: Haverty, Cindy 

Sent: Thursday, September II, 2008 12:29 PM 

To: ’JRO5ADO3@its.jnj.com ’ 

Cc: returntowellness 

Subject: Van Deventer Jr, Ralph-JOB ANALYSIS NEEDED 

YOUR ACTION NEEDED 

Please review the enclosed Job Analysis and confirm if the job duties are specific to your employee, lor update the job duties as needed and return the form via e-mail. The e-mail address is 

ReturrrToWellness@reedgroup.com . Please include either the employee’s name or case number in the subject line of your e-mail. In addition, please provide any pertinent information regarding 

this claimant that you feel might impact the disability management process. 

Thank you, 

Cindy loverly 

Reed Group 

15 Tech Valley Drive 

East Greenhush, NY 12051 

866.829.8861 

518.880.6610 FAX 

Page 15 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 23 of 57 PageID: 457
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Oct 

Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

ch ave rIy rg I. net 

http://www.rgl.net 

This e-mail and any attachments may he confidential or legally privileged. If you received this message 

attachments or copies and you are prohibited from retaining, distributing disclosing or using any information 

in error or are not the intended recipient, you should destroy the e-mail message and any 

contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

you for your cooperation. 

911512008 9/1512008 Task Lefton, Patrick Case Review Job Analysis 

please review attached JA 

9115/2008 9/1512008 Case Notes Pollen, Patrick Case Review Job Analysis 

9/1 512008 PR Reviewed job analysis. EE works as a Sr. Complaint Analyst. JA notes frequent lifting up to 10 Ibs, seldom up to 100 lbs. Seldom pushing, pulling, or reaching. Frequent sitting, 

occasional walking. 

9/1 512008 911812008 Task zzTeta, Cristina Case Review Case Follow -Up 

review for 8-day auth. 

9118/2008 Mail Merge zzRussell, Sharon Employee Notification STD/FMLA Approval Letter 

9119/2008 9/19/2008 Task zzBrache, Emily Employee Notification STD/FMLA Approval Letter 

send 

9/25/2008 9126/2008 Task zzTeta, Cnistina Employee Contact Case Follow-Up 

call as flu prior to 5-day call. 

9/26/2008 912612008 Phone Call zzTeta, Cristina Strouse, Irving (Dr.) Employee Contact ,Case Follow-Up 

9126 coal. NCM called as to f/u with progress. EE states going to PT 3Xa week, It does help, but mak9s 

short time as it makes his foot very stiff. ED not sure if CAM boot is helping. EE taking Anti infammatories 

and need for medical documentation to support extension if as not rtw on 10/6. EE will f/u with doctor 

him sore. Has fm with doctor on 9129. Still wearing Cam Boot. Takes it off at night for a 

and Hydrocodone at night which helps with stiffness and pain. NCM explained 5-day call 

during visit on 9/29, 

9129/2008 9129/2008 Task zzJackson, Latonya F Employee Contact Reminder Call for Extension or 

RTW 

5 day reminder call; authed thou I 0/05/08--lvm--1 have been informed by your case manager that your short term disability case was approved through 10/5108_with a return to work date 

of 1016/08, If you will not be returning to work on that date it will be necessary for you to submit add tional medical documentation to support the extended absence or your case will be closed 

and your continuation of Short Term Disability benefits will be denied. Please fax all pertinent medica documentation to 5I6’880-6610. If you are returning to work please fax a copy of your 

return to work release form to Reed Group at 518-880-6610. Thank you. 

9/3012008 9130/2008 Phone Call zzTeta, Cristina Employee Contact Case Follow-lip 

9/30 coal. Fe called with update. He faxed plow including ap form. Doc wants Ce out till 10127. also faxing PT script and list of rneds. 

9/30/2008 9/3012008 . Correspondence Felton, Patrick Forms Authorization to Disclose Medical 

Information 

Authorization to Disclose Medical Information 

Page 15ot 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 24 of 57 PageID: 458
Date Duo Date Compltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

9130/2008 9/3012008 Correspondence Pelted, Patrick Forms teimoursemeia t\9i551 I Silt 

Reimbursement Agreement - 

10/6/2008 101612008 Task zzTeta, Cristina Case Review Determination Extension 

review for rtw or deny 

10/1/2008 10/612008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached APS and AP note 

10/6/2008 10/612008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached medical info 

10/612008 10/6/2008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached medical info 

10/612008 101612008 Correspdndence zzTeta, Cristina Medical Documentation Case Information 

10/6 cant. Fe faxed list of medications and copy of script. Cyclohenzaprirn, Naproxin Carisorpudd Meloxicam Lortab Lexapro IKlonopin. PT 3x week. 

10/6/2008 101612008 Correspondence zzleta, Cristina Strouse, Irving (Dr.) I Medical Documentation Complete Medical 

1016 cmt. Reviewed aps. Tenosynovitis L ankle 727.06 Lumbar Sprain 847.2. Cam walker left foot. PIT 3 x week. HOOT 10117. est rtw 10127. 

101712008 10/7/2008 Phone Call zzTeta, Cristina Employee Contact Case Follow-lip 

10/7 cmt. Fe requested NCM to notify ce’s supervisor of revised rtw date of 10127. NCM will fax sups visor. FE attending PT 3X week. Helps with lower back. Still having foot pain and swelling. 

Continues to wear Cam hoot. 

101712008 10/712008 Correspondence zzTeta Cristina Rosado, Jose L Employer Notification RTW 

Please be advised, Mr. Van Deventers estimated return to work date has been extended to 10/27108 

Thank you, 

Cristinh Teta 

Reed Group 

15 Tech Valley Drive 

East Greenbush, NY 12061 

866.829.8861 

518..880.66I0FAX 

cteta'rgl.net 

http://www.rgl.net 

* 

m a 

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Oct 

Page 17 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 25 of 57 PageID: 459
to 

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Date Due Date Compltd Type Case Manager Person Contacted 

Notes 

This e-mail and any attachments may be confidential or legally privileged. If you received this m 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any 

Event Description Reference To 

in error or are not the intended recipient, you should destroy the e-mail message and any 

ition contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

10/712008 Mail Merge zzRussell, Sharon Employee Notification STD Extension Approval Letter 

STD FMLA Extension Aooroval Letter 

10/712000 101812008 Task Gibson, Heather Employee Notification STD Extension Approval Letter 

send std/fmla extension approval letter sent to qa by s b** 

10/2012008 1012012008 Task zzRussell, Sharon Employee Contact Reminder Call for Extension or 

RTW 

5 day reminder call; authed thru 10126/08 called ee at (732) 270-2897 and advised him as follows: l-Iello, this is a reminder call from the Reed Group, disability manager for Johnson & Johnson. 

I have been informed by your case manager that your short term disability case was approved through 10126/08 with a return to work date of 10/27108. If you will not be returning to work on that 

date it will be necessary for you to submit additional medical documentation to support the extendedl absence or your case will be closed and your continuation of your STD benefits will be denied. 

Please fax all pertinent medical documentation to 518-880-6610. If you are returning to work pleasel fax a copy of your return to work release form to Reed Group at 518-880-6610. Thank you for 

your c000era tion. *** 

1012012008 1012012008 Phone Call zzTeta, Gristina Message Received Case Follow-Up 

10120 cmt. Ee left message for call back. Needs RTW form faxed. Still having PT. Dr. has different nw date. -- - 

10/21/2008 1012112008 Correspondence zz’I’eta, Cristina Forms ’ Forms to Send 

10121 cant. RTW form faxed to ee. Efax successful. 

10/21/2008 10/21/2008 Phone Call zzTeta, Cristina Employee Contact Response to Message Left 

10121 cmt. NCM called ee. Had appt with ortho surgeon on 10/17. Saw improvement. Soot starting t work, but foot only half of what it should be. Keep ee in boot. Keep PT for 3 more weeks. EE 

still having numbness bothering left leg and lower hack, Had PT 10120. Soot is limiting PT as to what they can do. Foot still swollen. Doctor estimates ee will rtw on 11117108. NCM informed as he 

is authed turn 10/76 and to have nrovider fax office notes and PT scriot to Reed in order to extend case. EE verbalized understanding. 

10/24/2008 10/2412008 Phone Call zzTeta, Gristina Employee Contact Response to Message Left 

10124. NCM informed S his case will be extended thru 1 Ill 6with a rtw date of 11117. EE still has 9st. Going to PTstimes aweek, Has flu with provider air 11/10/08. Mother is in hospital has 

brain cancer. Only has one month to live. Hospice care. Mother will live with ee with hospice home care. - 

1012412005 10/2412008 Correspondence zzTeta, Cnistina Rosado, Jose L 

Please be advised, based on additional medical information received, Ralph Van Deventer’s 

Thank you, 

Cristina Teta 

Reed Group 

IS Tech Valley Drive 

East Greenbush, NY 12061 

866.829.8861 

518.880.66I0FAX 

cteta'rgLnet 

Page 18ot 105 

Employer Notification RTW 

has been extended through 11116/08, with an estimated return to work of 11/17/08. 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 26 of 57 PageID: 460
Date Due Date Compltd Typo Case Manager Person Contacted 

Notes 

http://w-ww.rgl.net 

Event Description Reference To 

Cc, 

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This e-mail and any attachments may be confidential or legally privileged. If you received this me 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any 

you for your c000eratiOn. 

10/2712008 Mail Merge zzRussell, Sharon 

STD FMLA Extensir 

in error or are not the intended recipient, you should destroy the e-mail message and any 

ration contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

Employee Notification STD Extension Approval Letter 

1012712008 10128/2008 Task Gibson, Heather Employee Notification STD Extension Approval Letter 

send std/fmla extension approval letterqa complete -- 

11/1012008 11110/2008 Task zzRussell, Sharon 

5 day reminder call; authed fhru Il/i 6108**called ee at (732) 881-0506 and Im as follows: Hello, this 

been informed by your case manager that your short term disability case was approved through 11/1 

will be necessary for you to submit additional medical documentation to support the extended absenr 

Please fax all pertinent medical documentation to 518-880-6610. If you are returning to work please 

your cooperation.*** 

Employee Contact Reminder Call for Extension or 

RTW 

a reminder call from the Reed Group, disability manager for Johnson & Johnson. I have 

)8 with a return to work date of 11117/08. If you will not be returning to work on that date it 

or your case will he closed and your continuation of your STD benefits will be denied. 

a copy of your return to work release form to Reed Group at 518-880-6610. Thank you for 

1012212008 1111112008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached AP note 

1Ô122/2008 11111/2008 Task zaTeta, Cristina - Case Review Fax Review 

PInnc rnr,inw oftorherl AP nntn 

11111/2008 11/1112000 Phone Call zzTeta, Cristina Employee Contact Case Follow-Up 

11111 cmt. EE called in with update. He saw ortho on 11110. ankle is looking better. Achilles doing goad, but sore in morning or when immobile for a period of time. EE still wearing CAM boot and 

continuing with PT 3 x perweek. Having lower back pain. Has MR] scheduled for 11/13. NCM informed ee he is authed thru 11/16. Reed needs to receive updated medical information by 11116 to 

extend case if not going back to work on 111I7 an said it seems unlikely he will rtw on 11117 consid4ing everything that is going on. 

11111/2008 11/1112008 Correspondence zzTeta, Cristina Strouse, Irving (Dr.) J Medical Documentation Case Information 

l III l cml. Reviewed doctor note dated 10/17. ee still having difficulty with both his lumbar spine and}achilles tendon. Achilles tendon continues to demonstrate a mass, which is palpable and 

tender. Back still reveals some residual spasm but negative straight leg raising and no neurologic deficits. Continue with PT, continue 00w. Return in one month. - 

11/1112008 11/11/2008 Correspondence zzTeta, Cdstina Strouse, Irving (Dr.) i Case Review Case Information 

11111 cmt. Reviewed Pt script dated 10/24. ee to continue with pt 3x per week for 3 more weeks. ------------- 

11/1412005 11114/2008 Phone Call zzTeta, Cristina - Employee Contact Case Follow-Up 

11/14 cmL Ee has doctor note keeping him new until 12/1108. ee will fax note to Reed Group. EE still sore. Hoping to go back to work on 12/1. Had MRI on 11113/08. Will be scheduling 

appointment with doctor to follow up. 

11114/2008 11/14/2008 Correspondence zzTeta, Cristina Rosado, ,Jose L Employer Notification RIW 

Please be advised, due to additional documentation received, Mr Van Deventer’s absence has been thru 11130108, with an estimated return to work date of 1211/08. 

Page 19 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 27 of 57 PageID: 461
C 

Date Due Date Compitd Type 

Notes 

Thank YOU 

Cristina Iota 

Reed Group 

15 Tech Valley Drive 

East Greenbush, NY 12061 

866829.8861 

518. 880.66 1OFAX 

c.teta @ rgi.net 

httpJ/www.rgLnet 

Case Manager Person Contacted Event Description Reference To 

ci ~o) 

0 C 

4-. 

c: E 

C’ -0 0< 

This e-mail and any attachments may be confidential or legally privileged. If YOU received this mess 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any infr 

you for your cooperation. 

le in error or are not the intended recipient, you should destroy the e-mail message and any 

mation contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

1111712008 11/18/2008 Task zzTeta, Cristina Case Review Case Follow-Up 

review for nw or denial 

1111212008 11118/2008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached med info - 

11/14/2008 11118/2008 Task z.zTeta, Cnistina Case Review Fax Review 

Please review attached med info 

11/17/2008 1I/1812008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached AP note 

11/17/2008 11/1812008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached AP note 

11119/2008 11/1812008 Task zzTeta, Cnistina Case Review Fax Review 

Please review attached medical info 

11/18/2008 1111812008 Correspondence zzTeta, Cristina Medical Documentation Complete Medical - Initial 

Il/lB cmt. Reviewed MRI results from I1fl3108. cc with chronic back pain. Disc bulge L4-L5 and L3R4 with a superimposed disc herniation in the right neural foramen at 1-4 - 1-5. Degenerative 

Changes. 

Page 20 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 28 of 57 PageID: 462
Date Due Date Conipltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

1111812008 1111812008 Correspondence zzTeta, Cristina Strouse, Irving (Dr.) Case Review Case Information 

11118 cent. Reviewed excuse slip. Fe now till 1211 for left achilles tendon and lumbar sprain. 

1111812008 1111812008 Correspondence zzTeta, Cristina Strouse, Irving (Dr.) Medical Documentation Complete Medical - Initial 

11/18 cmt. Reviewed provider note dated 11110108. Left Achilles tendon seems to be improved. Mass has decreased. Tenderness is less. FE continues with walking boot. FE still has significant 

lower back pain. No change in neurologic status, but he is c/a increased left sciatica. MD is ordering MRI of lumbar spine. Fe to continue with PT and return in one month. 

11/19/2008 11/1912008 Task Gibson, Heather Employee Notification . STD Extension Approval Letter 

send std/fmla extension approval letter. **sent to oa ... 

e b** 

11/1912008 11/19/2008 Phone Call zzTeta, Cristina I Employee Contact Case Follow-Up 

11/19 cmt. Fe called in to verify receipt of MR[ results. NCM confirmed receipt. FE has appt with Ort110 surgeon on 11124 and is going to PT today (11/19). NCM informed as he is authed thru 

11130 with est. Ow of 12/1108. If cc not rtw on 12/I Reed Group needs to have additional medical documentation submitted before 1211 in order to extend case. FE verbalized understanding. 

11119/2008 Mail Merge zz3rache, Emily Employee Notification SW Extension Approval Letter 

sent -FMLA 

1112012003 11120/2008 Phone Call Wadsworth, Mary Ellen Vaccaro***, Kathy Employer Contact Case Follow-Up 

11120108 mew: OHN called looking for update on case. Explained to OHN that ee has been auth’d through 11/30108. 

1112112008 11/21/2008 Phone Call zzTeta, Cristina Message Received Case Follow-Up 

11/21 cmt, Fe left message for call back re: rtw form questions. 

11/2112008 11/2112008 Phone Call zzTeta, Cristina Employee Contact Response to Message Left 

11121 cmt, Call placed to ee. FE has anxiety re: going back to work because healing is taking a long time. Saw psychiatrist for anxiety. EE will discuss restrictions with Ortho during visit on 11/24. 

EE wants to work from home part of the week when he goes back to work. Not sure if managerwill atcommodate. Going to PT 3 x a week. Going for two more weeks. 

iS ci 

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11124/2008 11/25/2008 Task zzJackson, Latonya 

5 day reminder call; authed thin 11/30108I have been informed by your case manager that yours 

of 12/1/08, If you will not be returning to work on that date it will be necessary for you to submit 

and your continuation of Short Term Disability benefits will be denied. Please fax all pertinent mad 

return to work release form to Reed Group at 518-880-6610. Thank von. 

- Employee Contact Reminder Call for Extension or 

R1W 

term disability case was approved through 11/30/08 with a return to work date 

itional medical documentation to support the extended absence or your case will be closed 

documentation to 518-880-6610. If you are returning to work please fax a copy of your 

1112612008 1112612008 Phone Call zzTeta, Cristina Message Received Case Follow-Up 

11/26 cunt, FE left message on 11/25. Had flu with ortho on 11/24. Discussed MRI results. PT now has permission to work ce’s back and feet for 4 weeks. Provider wants Ce now until 12129. Has 

f/u on 12122. If PT not helping, cc may have to go to Pain Mgmt. FE requested office notes be foxed to Reed Group. 

11/26/2008 11/2612008 Phone Call zzTeta, Cristina F Employee Contact Case Follow-Up 

11126 cant. FE called in. EE asked provider to fax over ppwto extend case. FE will Vu with NCM at 4rim today (11/26 to confirm if ppw received). 

11/26/2008 11126/2008 Correspondence zzTeta. Cristina 

Please be advised, due to additional documentation received today, Mr. Van Deventers std has 

Thank you, 

Cristina Teta 

Reed Group 

IS Tech Valley Drive 

East Greenbush, NY 12061 

Page 21 of 105 

Employer Notification Case Follow Up 

extended through 12/28/08 with an estimated return to work of 12129108. 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 29 of 57 PageID: 463
Date Due Date Compltd Type Case Manager Person Contacted 

Notes 

866.829.8861 

518.880.66I0FAX 

cteta@rgl.net 

http:llwww.rgLnet 

Event Description Reference To 

0) 

0 

0 

-ci C 

tE 

013 

0cc 

This e-mail and any attachments may be confidential or legally privileged. If you received this ME 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any 

vnu for your c000eration. 

in error or are not the intended recipient, you should destroy the e-mail message and any 

nation contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

121112008 12/2/2008 Task zzflrache, Emily Rosado, Jose L Employee Notification 511) Approvai/FMLA Exhaustion 

Letter 

send fmla exhaustion letter. sent to qa hg*** ..**QA completed, email sent** 

12/2/2008 Mail Merge Gibson, Heather Employee Notification SlDApproval/FMLA Exhaustion 

Letter 

STD Approval - FML.A Exhaustion Letter 

1112612008 1215/2008 Task zaTeta, Cristina Case Review Fax Review 

Please review attached medical into 

1211/2008 12/5/2008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached Al’ note 

121512008 12/512008 Phone Call zzleta, Cristina Message Received Case Follow-Up 

1215 cmt. EE called in re: We exhaustion letter received and status of std extension. - 

12/15/2008 1218/2008 Task zzTeta, Cristina Case Review Case Follow-Up 

mum’,, for ’1w or den in I - neceevtended . --------- 

121812008 121812008 Correspondence zzTeta, Cristina Strauss, Irving (Dr.) i Case Review Case Information 

12/8 cmt. Doctor’s note documented. Reviewed and note dated 11/24/08. FE with Achilled Tenosynoviis. Lumbar Sprain 1.4- L5. No work until 12/29108 

12/812008 121812008 Correspondence zzTeta, Cristina Strauss, living (Dr.) Case Review Complete Medical - Initial 

12/8 cart. Doctors note documented. Reviewed red note. Dated 11124. FE had MIR of L-spine. Disc bulge at L4-L5 with superimposed disc herniation along the right neural foramina at 1-4-1.5. 

Diffuse degenerative, change. FE still significantly tender over the Achilles. FE will continue physical terapy and be kept 00w, f/u in tour weeks.  

12/8/2008 121812008 Correspondence zzTeta, Cristina Strouse, Irving (Dr.) Case Review - Case Information 

12/8 colt . Documented rx. Reviewed rx for physical therapy. FE to have PT 3 x a week for4 weeks for back and ankle. Script dated 11/24/08. 

12/812008 12/812008 Correspondence zzTeta, Cristina 1 Case Review Case Information 

1218 colt. FE correspondence documented. FE had ov 11124. Doctor told ee that if after this round of PT there is still no improvement, doctor would recommend a pain mgmt treatment so that cc 

Page 22of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 30 of 57 PageID: 464
I 

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Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

can rtw. Doctor wants ee to remain oow until 12129108 while he participates in PT program. EE has f4u appt. on 12122/08 with Dr. Slrouse. - 

121812008 121812008 Phone Call zzTeta, Cristina Employee Contact Response to Message Left 

12/8 cmt. Physical therapy is going well. It is helping with back and foot. Progressing well. No longer using cam boot. Takes hydrocodone for pain pin. Usually just takes one at night. 

121912008 121912008 Task Gibson, Heather Employee Notification STD Extension Approval Letter 

send std extension aorroval letter.**sentto oa 12/9108*** 

121912008 Mail Merge zzRussell, Sharon Employee Notification STD Extension Approval Letter 

STD Extension Approval Letter 

1112612008 1211312008 Task zzMoussa, Kathleen Case Review STD Monthly Status Report 

STD Monthly Status Report 

11/1912008 1211312008 Task zzMoussa, Kathleen Case Review Case Management Plan 

Update CP 

12/1312008 1211312008 Case Review zzMoussa, Kathleen Case Review Care Plan - Back Pain 

Care/Case Management Plan 2: Low Back Injury/Disease 12/13/08 Ram 

Referral triggers: 

Lumbosacral sprain, intervetebral disc herniation, degenerative disease of the lower spine traumatic injuries; e.g. osteoarthritis, ankylosing spondylitis, congenital problems; scoliosis, instabilities; 

spondylolisthesis, organic diseases; tumors, Joint syndromes; facet syndrome, muscle inflammationj non specific back pain.12fl3/08 kam 

Problem #1: Employee is not achieving optimal health due to alteration in comfort: Pain 

90 Pay Report Template 

Age: 

Job title: 

1st Date of Disability: 

Diagnosis: 

Nature of surgery & date: (op report should be available for reference) 

Therapy: (dale started, how often, type ex- pt, rehab, counseling, oh st. Notes should be available to reference) 

Diagnostic Testing: (ran, emg, biopsy, x-ray, ect. Results should be available for reference) 

Job Duties: (lifting #, standing requirements, freq wrist movement, current class ect. JA should be a for reference) 

Co-morbids: (overweight, cardiac, previous miscarriages, ect) 

Plan: 1) Has case exceeded the optimum duration? 

02) It case has exceeded the optimum duration, please explain why. 

D3) Explain case management plan: - 

4)Has case been referred for review? (13101, peer, IME, ect. Include date and results) 

Page 23 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 31 of 57 PageID: 465
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5)Note any additional treatment plans: 

6) Has RTW been discussed including modified: 

Week 18: Ltd Application sent date: Received date: 

Ltd Roll Date: 

Short Term Goal: Employee will report a decrease in discomfort from initial assessment and a plan 

Long Term Goal: 

Employee will return to pre-injuryfillness pain free state within projected MDA guidelines. 

Interventions for short term goals: - 

flEducate the employee on possible complications and elimination of factors that precipitate pain. 

-[]Teach employee methods to reduce pain before it becomes too severe both pharmacological and 

breathing, repositioning, and divisional activities. 

’[iContact the employees physician to confirm the treatment plan, diagnoses, expected recovery tin - 

DFolloW up call to member at defined interval 

[lListeri to employee in a non judgmental manner. 

[lldentify barriers 

DOffer assistance and support 

Interventions for long term goals: 

DReview individual plan of action with the employee 

oAssess employee has made the needed changes in his/her medical treatment influencing disat 

DAssessment of functional ability/attainment of maximal functional ability. 

OTimely return to normal activities and employment. 

[lAppropriate utilization of resources 

lllAvoidance of unnecessary surgery, hospitalization, treatment and imaging studies. 

Clnstruction on prevention of re-injury and decreased disability 

[lPmovide knowledge on provision of quality, cost effective care 

-[)Ensure employee has a plan in place to address barriers. 

flProvide Human Resources with confidential reports and opportunities to improve your care and 

DReview individual plan of action with the employee and document in a written plan any accomrr 

Problem #2: Employee is riot achieving optimal health due to alteration in physical activity and 

Short Term Goal: 

1 [lEmployee will be knowledgeable of safety related issues due to activity limitations within three 

2.DEmployee will demonstrate increased mobility/activity utilizing appropriate DME equipment wit 

Long term Goal: 

Employee will progress to the highest level of mobility possible within limitations of diagnoses per 

Page 24 of 105 

be established to address needs. Within three days of employee contact, 

pharmacological methods for reducing pain/promoting comfort: hack rubs, stow rhythmic 

and expected MMI. 

duration. 

plans. 

designed to promote timely and safe transition back to full work productivity. 

to move purposefully within the environment. 

of employee contact 

e week of injury/illness. 

guidelines. 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 32 of 57 PageID: 466
Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

N 

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0 

0 

Notes 

Interventions for short term goals: 

[IEmployee will reduce or eliminate contributing factors by assess employees schedule. Allow rest p 

UAssist to identify safety hazards in members environment or daily routine 

’[lEncourage person to note daily progress. 

oEvaluate employees strength and degree of mobility through office notes or physical therapy notes 

oWork with Physical therapist to obtain current treatment plan 

DEvaluate for proper use of function and adaptive equipment 

-[]Evaluate proper referral to PT,OT, or other 

-[Encourage relaxation training 

Interventions for long term goals: 

*L]Assess employee has made the needed changes in his/her medical treatment influencing disabilit 

’UAssesment of functional ability/attainment of maximal functional ability. 

-0 timely return to normal activities and employment. 

llPlan and share necessity of learning outcomes with the employee. 

UAppropriate utilization of resources 

UAvoidance of unnecessary surgery, hospitalization, treatment and imaging studies. 

’Lllnstruction on prevention of re-injury and decreased disability 

oPrevention of possible complications 

llEnsure employee has a plan in place to address barriers. 

[Jprovide Human Resources and doctor with confidential reports and opportunities to improve your 

liTo achieve consistent, quality care by using nationally recognized clinical guidelines. 

Criteria for Case management closure 

-LiFunctiohal improvement 

nRelief/ reduction of pain and symptoms 

clAppropriate utilization of resources and benefits 

-[.]Avoidance of unnecessary surgery, hospitalization and surgery 

oEmployee satisfaction with medical care, case management services. 

-DEarly return to work 

LlSafety issues have been identified 

-UMedically cleared to return to work 

between all activities. 

and treatment plans. 

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Case Management Resources: 

U, 

http://w/vw.highbeam.comllibrary/ 

http://www.americanhealthways.com/regence/CBP/MemberJO2.asp?Clnt’OO1 &ProgCBP&CatK 

Aetna tow back manual 

Conte L, Timir B, The rehabilitation of persons with low back pain. Journal of Rehabiliation, April, 

The Medical Disability Advisor, Presley Reed, MD Fourth Edition 

http:/Iwww . rnce ntra Icorri/care plans/p lans/ai. html 

Praemer, A, Furner, S. Rice, U, Musculoskeletal Conditions in the United States, 1992, American 

Taylor V, Deyo R, Gherkin U, Kreeulter W. Freidlieb 0, The impact of managed care on the diagr 

1994. vol 91. 

Page 25 of 105 

of Orthopedic Surgeons. 

and treatment of low back pain: a preimiary report. American Journal of Medical Quality 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 33 of 57 PageID: 467
Event Description 

Meeting Candidate 

Reference To 

STD Monthly Status Report 

no 

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Date Due Date Compltd Type Case Manager Person Contacted 

Notes 

12113/2008 12/13/2008 Case Review zzMoussa, Kathleen 

12/13100 kam 

90 Day Report Template 

Age: 50 

Job title: Sr Compliance Analyst 

1st Date of Disability: 9/8/08 

Diagnosis: 

frmDisability Diag noses 

Description 

Lumbosacrat Spondylosis without Myelopathy; Arthritis; Osteoarthritis; Spondylarthritis 

Sprains and Strains of Other and Unspecified Parts of Back, Lumbar Spine 

Tenosynovitis of Foot and Ankle 

Degeneration of Thoracic or Lumbar Intervertebral Disc 

Nature of surgery & date: (op report should be available for reference) none 

Therapy: (date started, how often, type ex- pt, rehab, counseling, of, st. Notes should be available for 

Diagnostic Testing: (mn, emg, biopsy, x-ray, ect. Results should be available for reference) xray 

Job Duties: (lifting #, standing requirements, freq wrist movement, current class ect. JA should be ava 

Ibs, seldom up to 100 lbs. Seldom pushing, pulling, or reaching. Frequent sitting, occasional walking.e 

Co-morbids: (overweight, cardiac, previous miscarriages, ect) 

Plan: I) Has case exceeded the optimum duration? no 

2) If case has exceeded the optimum duration, please explain why. 

3) Explain case management plan: 

4)Has case been referred for review? (BMI, peer, IME, ect. Include date and results) no 

5)Note any additional treatment plans: 

6) Has RTW been discussed including modified: no 

Week 18: Ltd Application sent date: Received date: 

Ltd Roll Pate: 3/8109 

12/22/2008 12122/2000 Task zzJackson, Latonya 

5 day reminder call; authed than 12/28/08-1 have been informed by your case manager that your 

Page 26 of 105 

pt 

able for reference) : EE works as a Sr. Complaint Analyst. JA notes frequent lifting up to 10 

has heavy job class 

Employee Contact Reminder Call for Extension or 

RTW 

term disability case was approved through 12/28/08 with a return to work date 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 34 of 57 PageID: 468
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Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

of 12/29/08. If you will not be returning to work on that date it will he necessary for you to submit at medical documentation to support the extended absence or your case will be 

closed and your continuation of Short Term Disability benefits will be denied. Please fax all pertinent documentation to 518-880-6510. If you are returning to work please fax a copy of 

your return to work release form to Reed Group at 518-880-6610. Thank you. 

12129/2008 12/2612008 Task Wallace, Maria Network, Exam Coordinatbrs Case Review [ME-Independent Medical 

Examination 

please set-up ortho free. Per no, please make appt: as close as possible to his house as he has difficUlty with tong-distance driving. Thank you. 

1212612008 12/2612008 Phone Call zzTeta, Cristina i Employee Contact Case Follow-Up 

12126 cmt. Ee called in to check status of ppw. NCM verified ppw was received (pt script and referral tb pain mngmt.) NCM advised ee to have doctor submit office notes stating ees functional 

limitations. EE verbalized understanding and will f/u with provider on 12129 as office is closed today (I k/26). 

12/29/2008 12/2912008 Task zzleta, Cristina Case Review Determination Extension 

review for rtw or denial. 

12/2612008 12/29/2008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached medical info 

12/30/2008 12/29/2008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached medical info 

1212912008 12129/2008 Phone Call zzTeta, Cristina Employee Contact Case Follow-Up 

12129 cmt. Ee called in to check status of ppw. NCM informed ee that note from provider is dated 11/24. ee will f/u with provider for more recent notes. 

12/3012008 12/2912008 Task zzTeta, Cristina Case Review Fax Review 

Please review attached AP note 

12/29/2008 12129/2008 Phone Call zzTeta, Cristina Employee Contact Case Follow-Up 

12/29 cmt. Ee called in to verify receipt of ppw. Informed ee that 2nd note was received. 

12/2912008 12129/20b8 Correspondence zzTeta, Cristina Strouse, Irving (Dr.) Case Review Complete Medical - Initial 

12129 cmt. Reviewed ap note dated 11/24108. EE had MRI. Disc bulge at 14-15 and 134.4 with superiTposed disc herniation along the right neural foramina at L4-L5. Diffuse degeneratgive 

changes. Significantly tender over the Achilles. Neurologic exam remains unchanges. Plan for new is to continue PT and keep 00w. f/u in four weeks. 

1212912008 12/29/2008 Correspondence zzTeta, Cristina Strauss, Irving (Dr.) I 

I Case Review Complete Medical - Initial 

12129 cml. Reviewed ap note dated 12/22/08. ee is basically unchanged since 11/24 visit. Back is a chronic problem. Still has tenderness and swelling. Exam reveals spasm and limited motion. 

There is no change in his neurologic status. Still tender with swelling over the Achilles. Plan for now istto continue with PT. Also being referred to pain management specialist to see if epi blocks 

are indicated. flu in one month. [ME has been requested. 

1212912000 1212912008 Correspondence zzTeta, Cristina Strauss, Irving (Dr.) Case Review Complete Medical - Initial 

12/29 cml. Reviewed medical documentation received 12/25/08. Cover note from ee dated 12/23108: EE saw ortho surgeon on 12/22. Wants ee 00w one more month. Needs to undergoe ipidural 

block injections. Has f/u with Dr. Spouse on 1/20109. estimated rtw is 1/29109. Included: exuse slip for dates 12122 - for one month. Script for PT dated 12/22 - continue PT for 3 x week for 4 more 

weeks. Referral to Pain Management Specialist consult dated 12/22108. IME has been reqested (still waiting for appointment date), will extend case out to 1/28/09 with estimated rtw 1/29, pending 

IME results. I - 

1213112008 12/30/2008 Task zzMcRae, Megan Network, Exam Coordinatrs Vendor Contact [ME Attempt to Schedule 

Call for the time and date of Ortho IME 

12/30/2008 Mail Merge zzRussell, Sharon Employee Notification STD Extension Approval Letter 

STD Extension Approval Letter 

12130/2000 12/3112008 Task Gibson, Heather Employee Notification STD Extension Approval Letter 

send std extension approval letter. sent to no l2/30108* 

Page 27 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 35 of 57 PageID: 469
Date Due Date Compltd Type Case Manager Person Contacted 

Notes 

11212009 11212009 Task zzMcRae, Megan Employee Notification ME Notification 

Send EE [ME Notification Letter for 1/13/2009 at 5pm with Dr. Heyman (HOPELAWN) 

11212009 1/2/2009 Task zzMcRae, Megan Network, Exam Coordinators Correspondence ME Notification 

Send Provider [ME Notification Letter for 1/1 312009 at 5pm with Dr. Heyman, own 0cc 

1/2/2009 1/212009 Mail Merge zzMcRae, Megan Employee Notification IME Notification 

Sent EE [ME Notification Letter i 

1/212009 1/2/2009 Mail Merge zzMcRae, Megan Network, Exam Coordinatbrs Correspondence ME Notification 

Sent Provider IME Notification Letter 

1/9/2009 119/2009 Task Wallace Maria Employee Contact ME-Independent Medical 

Examination 

Call EE to remind of ME on I/I 312009 at 5 p with Dr. Heyman 

119/2009 119/2009 Phone Call Brannock, Susan Spoke to IME-Independent Medical 

Examination 

spoke to ee to remind of ME on 1/13/2009 at 5pm with DL Heyman 

I/I 2/2009 1/1 212009 Task Pelton, Patrick Employee Notification LTD Application 

1112/2009 Mail Merge Potion, Patrick i Choices LTD Application 

LTD Application 

1114/2009 1/14/2009 Task zzMcRae, Megan Network, Exam Coordinatrs Vendor Contact ME-Independent Medical 

Examination 

Call for next-day verbal 

111412009 1/14/2009 Correspondence zzMcRae, Megan Network, Exam Coordinators Correspondence ]ME Attendence Confirmation 

Good morning, 

The claimant above DID show for his ME yesterday afternoon. 

As soon as the report is received, we will email it over to you. 

Thank you, 

Cathy Smith 

Director of Operations 

Exam Coordinators Network - 

123 NW 13th Street, Suite 207 

Boca Raton, FL 33432 I 

Tel 877.463,9463 

Fax: 561.392.5881 

Page 28 of 105 

Event Description Reference To 

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Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 36 of 57 PageID: 470
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Date Due Date Compltd Typo Case Manager Person Contacted Event Description Reference To 

Notes 

Email: csmith@ecnime.com 

111412009 Mail Merge zzBrache, Emily Employer Notification Initial OHN2 Contact - 

1127/2009 111512009 Task zzMcRae, Megan Network, Exam Coordinators Vendor Contact ME-Independent Medical 

Examination 

Call for final ME report from 111312009 at 5pm with Dr. Heyman 

1115/2009 111 5/2009 Correspondence zzMcRae, Megan Network, Exam Coordinators Correspondence [ME Final Report Received 

Received final [ME report 

1116/2009 1/16/2009 Task zzTeta, Cristina Case Review Fax Review 

]ME Report 

1/1912009 1/19/2009 Task Peters, Jamie Case Review Case Information 

update non 

1119/2009 1/19/2009 Task Peters, Jamie Strouse, Irving (Dr.) Case Review Case Follow Up 

fax IME to provider. 

1119/2009 111912009 Correspondence Peters, Jamie Strouse, Irving (Dr.) Correspondence Case Information 

2:38 PM 1/1912009 Transmission Record 

OSent to: Dr. Irving Strouse 

[]Phone: 417325711937 

IlBitling information:"," 

CRemate ID: 7325711937 

DUnique ID: ’JPE4974904B5AB2" 

[lElapsed time: 1 minutes, 54 seconds. 

Dtlsed channel 2. 

L]No ANt data. 

DNa AOC data. 

DResulting status code (0/339; 0/0): Success 

[]Pages sent: 1 -7 

2:46 PM 1/1912009 View Record 

[]Viewed by: -PETERS 

1119/2009 1/1912009 Case Notes Peters, Jamie Case Review Care Plan - Back Pain 

Care/Case Management Plan 2: Low Back Injury/Disease 12/13108 kam 

Referral triggers: 

LumhosScral sprain, intervetebral disc herniation, degenerative disease of the tower spine traumatic injuries; e.g. osteoarthritis, ankylosing spondylitis, congenital problems; scoliosis, instabilities; 

spandylolisthesis, organic diseases; tumors, Joint syndromes; facet syndrome, muscle inflammation, on specific back pain.12/1 3/08 karn 

Problem #1: Employee is not achieving optimal health due to alteration in comfort: Pain 

90 Day Report Template 

Age: 

Page 29 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 37 of 57 PageID: 471
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C: E 

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Oct 

Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

Co 

0 

0 

Notes 

Job title: 

1st Date of Disability: 

Diagnosis: 

Nature of surgery & dale: (op report should be available for reference) 

Therapy: (date slatted, how often, type ex- p1, rehab counseling, of, st. Notes should be available 

Diagnostic Testing: (mn, emg, biopsy, x-ray, ect. Results should be available for reference) 

Job Duties: (lifting It, standing requirements, freq wrist movement ) current class ect. JA should be 

Co-morbids: (overweight, cardiac, previous miscarriages, ect) 

Plan: 1) Has case exceeded the optimum duration? 

2) If case has exceeded the optimum duration, please explain why. 

3) Explain case management plan: 

4)1-las case been referred for review? (3M1, peer, IME, ecL Include date and results) 

5)Note any additional treatment plans: 

6) Has RTW been discussed including modified: 

Week IS: Ltd Application sent date: Received date: 

IUIt51II*11fl 

Short Term Goal: Employee will report a decrease in discomfort from initial assessment and a plan 

Long Term Goal: 

Employee will return to pre-injury/illness pain free state within projected MDA guidelines. 1/1 9/09 JP 

Interventions for short term goals: 

’LlEducbte the employee on possible complications and elimination of factors that precipitate pain. 

’OTeach employee methods to reduce pain before it becomes too severe both pharmacological and 

breathing, repositioning, and divisional activities, 

-1-]Contact the employees physician to continn the treatment plan, diagnoses, expected recovery tim 

DFollow up call to member at defined interval 

’r]Listen to employee in a non judgmental manner. 

’Oldentify harriers 

’GOffer assistance and support 

Interventions for long term goals: 

’OReview, individual plan of action with the 

Page 30 of 105 

for reference) 

be established to address needs. Within three days of employee contact, 

pharmacological methods for reducing pain/promoting comfort: back rubs, slow rhythmic 

and expected MMI. 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 38 of 57 PageID: 472
Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

co 

C" 

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0 

Notes 

.[]Assess employee has made the needed changes in his/her medical treatment influencing disat 

-[]Assessment of functional abilitylattainment of maximal functional ability. 

tlTimely return to normal activities and employment. 

[iAppropriate utilization of resources 

oAvoidance of unnecessary surgery, hospitalization, treatment and imaging studies. 

’Dlnstruction on prevention of re-injury and decreased disabilityl/1 9109 JP 

[]Provide knowledge on provision of quality, cost effective care 

tiEnsure employee has a plan in place to address barriers, 

’OProvide Human Resources with confidential reports and opportunities to improve your care and 

tiReview individual plan of action with the employee and document in a written plan any accomm 

Problem #2: Employee is not achieving optimal health due to alteration in physical activity and 

1/19/09 JP 

plans. 

designed to promote timely and safe transition back to full work productivity. 

to move purposefully within the environment. 

coo 

D C 

4’ 

Short Term Goal: 

I .DEmployee will be knowledgeable of safety related issues due to activity limitations within three days of employee contact 

2.CEmployee will demonstrate increased mobility/activity utilizing appropriate DIVE equipment within ne week of injury/illness, 

Long Term Goal: - 

Employee will progress to the highest level of mobility possible within limitations of diagnoses per 

Interventions for short term goals: 

[]Employee will reduce or eliminate contributing factors by assess employees schedule. Allow rest 

’DAssist to identify safety hazards in members environment or daily routine 

OEncourage person to note daily progress. 

oEvaluate employees strength and degree of mobility through office notes or physical therapy notes 

UWork with Physical therapist to obtain current treatment plan -1/19/09 JP 

1]Evaluate for proper use of function and adaptive equipment 

tlEvaluate proper referral to PT,OT, or other 

CEncourage relaxation training 

Interventions for long term goals: 

oAssess employee has made the needed changes in his/her medical treatment influencing disabilit 

ijAssessment of functional ability/attainment of maximal functional ability. 

’tilTimely return to normal activities and employment.1/19109 JP 

’OPlan and share necessity of learning outcomes with the employee. 

oAppropriate utilization of resources 

’liAvoidance of unnecessary surgery, hospitalization, treatment and imaging studies. 

olnstruction on prevention of re-injury and decreased disability 1119109 JP 

’oPrevention of possible complications-1/19/09 JP 

11]Ensure employee has a plan in place to address barriers, 

’{lProvide Human Resources and doctor with confidential reports and opportunities to improve your 

OTo achieve consistent, quality care by using nationally recognized clinical guidelines. 

Criteria for Case management closure 

’[IFunctional improvement 

oRelief / reduction of pain and symptoms 

-[]Appropriate utilization of resources and benefits 

OAvoidance of unnecessary surgery, hospitalization and surgery 

[iEniployee satisfaction with medical care, case management services. 

CEarly return to work 

’[]Safety issues have been identified 

1/19/09 JR 

between all activities, 1119/09 JP 

and treatment plans. 

Page 31 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 39 of 57 PageID: 473
Date Due Date Cornpltd Typo Case Manager Person Contacted Event Description Reference To 

0) cc) 

0 

0 

Notes 

cleared to return to work 

Case Management Resources: 

ci 

http:/lwww.highbeam.comllibrary/ 

http:Ihwtw.americanhealthways.comlregencelCDP/Memberl02.asp?Clnt00I &Prog=CBP&CatMt 

Aetna low back manual 

Conte L, their B, The rehabilitation of persons with low back pain. Journal of Rehabiliation, April, I 

The Medical Disability Advisor, Presley Reed, MD Fourth Edition 

http:/Iwww.rncentral.comlcareplanslplanslai.html 

Praemer, A, Furner, S Rice, D, Musculoskeletal Conditions in the United States, 1992, American I 

Taylor V Deyo R, Cherkin D, Kreeulter W. Freidlieb 0, The impact of managed care on the diagno 

1994. vol 91. 

of Orthopedic Surgeons, 

treatment of low back pain: a preimiary report. American Journal of Medical Quality 

.i2 0 

1) 

t) C 

E E 

013 

Oct 

1119/2009 1/2012009 Task zzTeta, Cristina Case Review STD Monthly Status Report 

112012009 1/2012009 Case Review zzMoussa, Kathleen Meeting Candidate STD Monthly Status Report 

1120109 kam 

120 Day Report Template 

Age: 

Job title: Sr Compliance Analyst 

1st Date of Disability: 919108 

Diagnosis: 

rrrnDisahility..Diagnoses 

Description 

Lumbosacral Spondylosis without Myelopathy; Arthritis; Osteoarthritis; Spondylarthritis 

Sprains and Strains of Other and Unspecified Parts of Back, Lumbar Spine 

Tenosynovitis of Foot and Ankle 

Degeneration of Thoracic or Lumbar Intervertebral Disc 

Nature of surgery & date: (op report should be available for reference) none 

Therapy: (date started, how often, type ex pt, rehab, counseling, at, st. Notes should be available for 

Diagnostic Testing: (mil, emg, biopsy, x-ray, oct. Results should be available for reference) xray 

Job Duties: (lifting It, standing requirements, freq wrist movement, current class act. JA should be ava 

lbs, seldom up to 100 lbs. Seldom pushing, pulling, or reaching. Frequent sitting, occasional walking.e 

pt 

ble for reference): EE works as a Sr. Complaint Analyst JA notes frequent lifting up to 10 

has heavy job class 

Page 32 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 40 of 57 PageID: 474
Event Description Reference To 

0 

0 

0 

,S L 

-o C 

Lçz c: E 

C ’0 

0cc 

Date Due Date Compttd Type Case Manager Person Contacted 

Notes 

Co-morbids: (overweight, cardiac, previous miscarriages, ccl) 

Plan: 1) Has case exceeded the optimum duration? no 

02) If case has exceeded the optimum duration, please explain why. 

93) Explain case management plan: 

4)Has case been referred for review? (DM1, peer, ME, act. Include date and results) no 

1/20109 kam ]ME done on 111 3/09 ee may return to work but has some restrictions. (me faxed to 

5)Note any additional treatment plans: 

6) Has RON been discussed including modified: no 

Week 18: Ltd Application sent date: Received date: 

iflItflMIsflJ14Jfflu] 

1/28/2009 112112009 Task zzTeta, Cristina 

awaiting rod response 

Employee Contact Case Follow-Up 

call 

112112009 1/2112009 Phone Call zzTeta, Cristina i Employee Contact Case Follow-Up 

1121 cmt. EE attended IME. EE states very nice doctor. Took his time with cc. EE met on 1119 in pain institute as referred by dr. strouse for pain management. EE gave history. Dr. Strouse states 

pain mgmt. recommends ei bloc procedures. Health insurance being called for pre-approval. Ee he es to get in to see pain mngmt. For epi block. Ee was supposed to see or strouse on 1120, but 

doctor had to cancel appointment EE off phone with doctor on 1/21 still no appointment rescheduled with dr. strouse. EE feeling pretty much the same. Going to PT 2-3 times per week. Still 

having pain lower back pain, sciatica. If not careful, upper back also. 

1/21/2009 112112009 Phone Call zzTeta, Cristina Employee Contact Case Follow-Up 

1121 cmL Ee called in to ask for IME report. Referred EE to primary doctor. EE states primary said they couldn’t give results and to call Reed Group for results. NCM will review with CCM. EE 

discussed going back to work part-time. NCM advised cc to have provider submit nw notice with restictions listed. Ee verbalized understanding. 

1/23/2009 1/23/2009 Task zzRussell, Sharon Employee Contact Reminder Call for Extension or 

RTW 

5 day reminder call; authed thru 1128109***called cc - and advised him as follows: F 

All calls are recorded for quality assurance. I have beiThiformed by your case manager that your st 

you will not be returning to work on that date it will be necessary for you to submit additional medical 

continuation of your STD benefits will be denied. Please fax all pertinent medical documentation to 

form to Reed Group at 518-880-66l0. Thank you for your cooperation ,*** 

ho, this is a reminder call from the Reed Group, disability manager for Johnson & Johnson. 

-t term disability case was approved through 1/28/09 with a return to work date of 1129109. 

ocumentation to support the extended absence or your case will be closed and your 

8-880-6610. If you are returning to work please fax a copy of your return to work release 

1123/2009 1/2312009 Task zzTeta, Cristina Case Review Fax Review 

Please review attached medical into 

112312009 1/23/2009 Correspondence zzTeta, Cristina Case Review Case Information 

1123 cmt. Reviewed letter written by cc dated 1/21 sent to NCM’s attention. EE referencing two medical documents included in fax. 1.)EE questioning it doctors note provided (from 912008) 

allowing cc to work part-time from home is sufficient to allow him to begin working part-time. EE stateshis primary and the IME provider could not understand why employer (Ce’s manager) will not 

accommodate part-time as it would benefit the company. EE asking NCM to negotiate with JnJ. 2.) EE provided copy of note from psychiatrist office regarding treatment received. EE states he is 

seeing psychiatrist because ce’s current back condition has caused cc to to accept that he may nev& get better. This has caused cc to fell depressed and anxious. EE is also anxious about his 

job status. He feels he is afraid he is running out of time due to recent delays with his surgeon and pain management dolor and whether recent IME is in agreement with surgeon’s 

diagnosis/conclusions. How does that translate to LTD approval or appeals or if cc loses job. 

Page 33 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 41 of 57 PageID: 475
Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 0 

0 

Notes 

1123/2009 1123/2009 Correspondence zzTeta, Cristina Strouse, Irving (Dr.) Case Review Case Information 

1/23 cml. Reviewed excuse slip dated 9/I1/08. Diagnosis - osteoarthritis, labor spine. Lumbar sprain, Left ankle Tenosynovitis. Patient able to work 2 hours a day from home. (no end date to 

restriction F 

112312009 1/23/2009 Correspondence zzTeta, Cristina Cavanaugh, Colleen (Dr.) Case Review Case Information 

1/23 cmt Reviewed Doctors note dated 1/13109 EL has been under psychiatric care since 9/17/08 He is suffering from anxiety and depression Taking medications (mbeds not listed) 

0) 

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4’. c: E 

C) 0 

0cC 

Case Review ]ME-Independent Medical 

Examination 

inning at ce’s job because he is unable to really bend and lift. He can sit, if he sits 

ith proper coaching and proper teaching and sitting with a lumbar roll, he could possibly sit 

his lower extremity muscles along with the muscles in his back, and based upon the 

ry for cc. ]ME provider feels cc capable of performing current lob in the SEDENTARY 

squires he air walking CAM boot. He can be treated with either a lift inside the shoe or a lift 

g and walking minimally, but does NOT think that cc can lift and put something up on a top 

el, standing for long periods of time, sitting for long periods of time, EE is capable of sitting 

time. ]ME provider thinks cc is capable of working 8 hours a day, but he will have to take 

lumbar roll in the lumbar lordis to put the least amount of load and the least amount as strain 

boot and put him in a shoe with a heel pad to elevate his heel or build up the outside of the 

on a particular program to stretch hamstrings and stretch the piriformis on a daily basis and 

xtennsor. The use of heel lift and heel pads should be until the swelling is down and he is 

monitored for a short period of time at most 3 to 4 weeks, but need to continue for the rest 

1123/2009 1/2312009 Correspondence zzTeta, Cristina 

1/23 cmt. [ME documented. VAE provider states current condition is partially preventing EE from fun 

comfortably and properly in a chair, he indated that he is unable to sit for longer than a half hour, but 

for longer. For as to stand longer, he has to be able to exercise and strengthen his trunk muscles an( 

exercises mentioned by cc, IME provider feels none of these exercises will accomplish what is neces 

position and in walking around and standing for short periods of time. IME provider feels cc no longei 

outside the shoe to protect the Achilles Tendon Therfore, IME provider thinks no can perform his sift 

shelf shoulder level. Functions cc NOT capable of: lifting heavy objects and bring them to shoulder It 

for short periods of time with occasional standing and walking around and standing for short periods 

frequent breaks, be able to stand and walk around with certain frequency and he must be sifting with 

on his back. ME provider DOES NOT AGREE with treatment to date. Recommends getting as out 

shoe. Thinks that exercises for Ce’s Achilles tendon and for his foot are not indicated and he should 

he should be on a stengthening exercise program for his trunk, lower back muscles, quads and knee 

comfortable, which may be 6-8 months, exercises need to be started irniTiediateley and they should If 

of his life. Must also have lumbar roll whenever and wherever he sits. 

1/27/2009 1/27/2009 Case Review Terry, Sherry Employee Notification LTD Application 

Follow-up regarding LTD application. 

1/2712009 1/27/2009 Task zzTeta, Cristina Case Review Case Information 

Look for ME response from AP 

1/27/2009 1127/2009 Correspondence Terry, Sherry Case Review LTD Application Review 

No lTD application recd mailed 1/12/09 -IME scheduled for this 50 year old analyst 

112712009 112712009 - Phone Call ,. zzTeta, Cristina F Employee Contact Response to Message Left 

1127 cmt. Call placed to Ce. Informed cc NCM will send reverse auth in order to send ME results. Will also be sending rtw note for his appt, today on 1127/09 for doctor to fill in 2 hour a day 

restriction with end date to restriction Informed ee we will he saltine un neuro osvche exam due to diAonosis of deoression. cc verbalized understanding. 

112712009 112712009 Correspondence zzTeta, Cristina Forms Forms to Send 

1/27 cart. Faxed rtw form to cc. 

1/27/2009 1127/2009 Correspondence zzTeta, Cristina Forms Forms to Send 

1127 cnit. Faxed reverse auth to cc. 

1/28/2009 112712009 Task zzMcRae, Megan Access, Medical Evaluations Case Review ME Attempt to Schedule 

please set up neuro psyche 1ME for cc 

 

112712009 1/2712009 Case Notes zzTeta, Cristina Case Review Case Follow-Up 

1/27 cant. Noresponse from ce’s pop re: ME EE is being set up for neuro psyche ]ME 

1/2712009 1127/2009 Correspondence zzMcRae, Megan Access, Medical Evaluativns Correspondence ME Attempt to Schedule 

Referral ] 

Page 34 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 42 of 57 PageID: 476
Date Due Date Cornpitd Type Case Manager Person Contacted Event Description Reference To 

Notes 

112812009 1128/2009 Task zzTeta, Cdsthia Employee Notification Case Follow-Up - 

send reverse auth to cc. 

1128/2009 1/28/2009 Task zzTeta, Cristina Case Review Fax Review 

Please review attached reverse auth 

1/30/2009 1/2812009 Task zzMcRae, Megan Access, Medical Evaluatihns Vendor Contact ME-independent Medical 

Examination 

Call for time and date of NPSY IME, own 0cc 

1/28/2009 112812009 Phone Call zzTela, Cristina Case Review Fax Review 

1/28 cunt, Reviewed signed reverse auth. Ee requesting copy of ime. 

112812009 1128/2009 Phone Call zaTeta, Cristina Message Received Case Fallow-Up 

1/28 cmL Ee left message. States orlho surgeon claims he never received copy of ME. Ee left number for call back to discuss. 

112812009 1/2812009 Phone Call ’ zaTeta, Cristina I Message Left Response to Message Left 

1128 cmL Left message on ee vm for call back. Left ncm name, If and Reeds hours of service. 

112812009 112812009 Phone Call zzTeta, Cristina Employee Contact Case Follow-Up 

saw pain management. Had first epi block on 1/26/09. scheduled for 2nd epi block on 2111109 and mqy be scheduled for 3rd epi block. Dr. strouse wants pt group to continue to work on foot and 

hack. Ee did discuss pad time hours with dr, strouse and dr will review and fax back to Reed Group, 0, ain mgmt is Dr. Quinnoes, pain institute in Brick, NJ. 732-477-4242. 

112812009 1/28/2009 Correspondence zzleta, Cristina Employee Notification [ME-independent Medical 

Examination 

1128 cmt. Faxed ]ME to cc, 

1/28/2009 1/2812009 Correspondence zzTeta, Cristina Strouse, Irving (Dr.) Provider Contact IME-Indeperident Medical 

Examination 

1/28 con. Faxed ime to provider.(2nd time faxed - provider claims he never received first [ME faxed). 

1/28/2009 1/28/2009 Task zzMcRae, Megan Employee Notification ME Notification 

Send EE [ME Notification Letter for 2112/2009 at lOam with Dr. Kutner, bring snack or lunch (CRANBjJRY) - 

1/28/2009 1/28/2009 Task zzMcRae, Megan Access, Medical Evaluations Correspondence IME Notification 

Send Provider ME Notification Letter for 2112/2009 at lOam with Dr. Kutner, own 0cc 

1/28/2009 1/28/2009 Mail Merge zzMcRae, Megan Employee Notification ]ME Notification 

Sent EE ME Notification Letter 

1/28/2009 112812009 Mail Merge zzMcRae, Megan Access, Medical Evaluatibns Correspondence ]ME Notification 

Sent Provider ME Notification Letter 

1/28/2009 Mail Merge zzJackson, Latonya Employee Notification STD Extension Approval Letter 

STD Extension Approval Letter 

112912009 ’1129/2009 Task zzTeta, Custina Case Review Fax Review 

Please review attached RTW and other medical info 

1/29/2009 1/2912009 Phone Call zaleta, Cristina Strouse, Irving (Dr.) Provider Contact Case Follow-Up 

1/29 cml. Call placed to AP. Confirmed restrictions listed on release to work form will last at least until the visit on 3/3109. 

1/29/2009 1/29/2009 Correspondence zzTeta, Cristina Strouse, Irving (Dr.) I Case Review RTW 

1129 cml. Reviewed nw note dated 1128109. EE may return to work on 212/09 with the following restricions. May only work 3-4 hours per day from home in sedentary capacity. 

Page 35 of 105 

(0 Q 

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9-. 

o 

Oct 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 43 of 57 PageID: 477
OD 

Event Description Reference To g 

ni C5 

Case Review Complete Medical Initial 03 

ed. Less tenderness and better strength. May be weaned out of walking boot. Back pain - 

DC 

eks. No change in neurologic status. Does appear to be able to work limited duty, four hours o t 

Employer Notification RTW 

Date Due Date Compltd Type Case Manager Person Contacted 

Notes 

2009 112912009 Correspondence zzleta, Cristina Strouse, Irving (Dr.) 

1129 cmt. Reviewed office note dated 1127109. ee much improved as far as Achilles tendon is conc 

has seen pain mgmt. specialist and has had one epidural block so far. Another is scheduled in two 

1/2912009 1/29/2009 Correspondence zzTeta, Cristina Rosado, Jose 

Mr. Rosario, 

Please be advised, Mr. Van Deventer has been cleared to return to work on 2/2109 with the following ie 

most of time No twisting, squatting, climbing. Brief periods of walking or standing, may only lift up to in 

scheduled to be re-evaluated by his physician. Please confirm if you are able to accommodate these 

Thank you, 

Cristina Teta 

Reed Group 

15 Tech Valley Drive 

East Greenbush, NY 12061 

066.829.8061 

510.880.661 OFAX 

ctetargl.net 

http://www.rgl.net 

ns: May only work from home 4 hours per day. May only do sedentary work (Sitting 

These restrictions would last at least until 3/3/09 at which time Mr. Van Deventer is 

ns. Thank you for your help. 

This e-mail and any attachments may be confidential or legally privileged. If you received this m 3 in error or are not the intended recipient, you should destroy the e-mail message and any 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any nation contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

You for your cooperation. 

1130/2009 1129/2009 Task zzTeta, Cristina I Case Review Case Follow-Up 

look for response to email sent on 1/29. Able to accommodate restrictions?? 

1/29/2009 1/2912009 Phone Call zzTeta, Cristina Rosado, Jose Employer Contact RTW 

1/29 curt. Ee’s supervisor called in. confirmed that restrictions cannot be accommodated, also claims questionnare filled out as to why restrictions cannot be accommodated. 

1/2912009 1/2912009 Phone Call zzTeta, Cristina Employee Contact RTW 

1129 curt. Call olaced to cc. Left messaoe on ee vm statino restrictions cannot he accommodated. 

Page 36 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 44 of 57 PageID: 478
Date Due Date Corapltd Type Case Manager Person Contacted Event Description Reference To I’ 

Notes 

112912009 112912009 Phone Cat zzTeta, Cristina I Employee Contact Case Follow-Up 

1129 cnit. Fe called in. He if faxing over PT notes. Wanted to know how ime doctor and his own doctors opinion (if they differ) effect LTD determination status. NCM informed ee he is scheduled 

for Neuroosvch IME and resuts would be reviewed. EE verbalized understanding. I 

1/30/2009 1/3012009 Correspondence zzTeta, Cristina Rosado, Jose Case Review RTW 

The type of work that Mc VanDeventer does cannot accomodate working from home. I can provide details on the reasons why if you wish. We had indicated this in the paperwork that was 

submitted recently. 

cab 

0) 

0 0: 

CD 

0< 

----Original Message 

From: Tula, Cristina [mailto:cteta@rgl.net] 

Sent: Thursday, January 29, 2009 1:33 PM 

To: Rosado, JosØ Luis [OCOUSI 

Cc: Vaccaro, Kathryn [OCDUS} 

Subject: Mr. Ralph R. Van Deventer Jr. 

Mr. Rosado, 

Please be advised ! Mr. Van Deventer has been cleared to return to work on 2/2/09 with the following 

most of time. No twisting, squatting, climbing. Brief periods of walking or standing, may only lift up to 

scheduled to be re-evaluated by his physician. Please confirm if you are able to accommodate these 

Thank you, 

Cristina Teta 

Reed Group 

15 Tech Valley Drive 

East Greenbush, NY 12061 

866.829.8861 

518.680.66I0FAX 

ctetargLnet 

http://wvm.rgl.net 

us: May only work from home 4 hours per day. May only do sedentary work (Sitting 

These restrictions would last at least until 313109 at which time Mr. Van Deventer is 

os. Thank you for your help. 

This e-mail and any attachments may be confidential or legally privileged. If you received this mr in error or are not the intended recipient, you should destroy the e-mail message and any 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any ation contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

Page 37 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 45 of 57 PageID: 479
Date Due Date Compltd Typo Case Manager Person Contacted Event Description Reference To 

Notes 

you for your cooperation. 

2/9/2009 212/2009 Phone Call zzTeta, Cristina Employee Contact Case Follow-Up 

11 am appt at 2/9 went to pain management for 2nd epidural block. First injection had no results. Has appt. 2123 for third injection. Sprained left ankle after fall in driveway on 214. Became swollen 

black and blue, cc iced and elevated lie. Helped a little bit. Able to walk on leg. Using cane. Pain lnsitute - 732-477-4242. Dr. Quinones, Brick, NJ. 

1/28/2009 213/2009 Task Gibson, Heather Employee Notification STD Extension Approval Letter 

send std extension approval letter.**sent to qa ** 

214/2009 21412009 Task zzTeta, Cristina Case Review Fax Review 

Please review attached medical info 

2/212009 214/2009 Task Decrescenzo, Rachael Case Review Fax Review 

Please review attached application 

2/312009 21412009 Task Decrescenzo, Rachael I Case Review Fax Review 

Please review attached app forms 

214/2009 2/4/2009 Correspondence Wallace, Maria Network, Exam Case Review ME-Independent Medical 

Examination 

Hi Rick, 

Please check into this allegation and provide Reed a written statement from the [ME provider. 

Thank you, 

Maria 

214/2009 21412009 Correspondence zzMcRae, Megan Correspondence ME-Independent Medical 

Examination 

Received ME complaint from EE, attached in case and forwarded to vendor 214/2009 

21412009 2/412009 Correspondence zzTeta, Cristina Case Review Case Follow-Up 

214 cmt. Reviewed letter from on dated 1129. EE disagrees with some of the information put forth in the IME. EE details each concern/complaint. NCM forwarded copy of letter to [ME team who 

will f/u with ME provider. 

21612009 216/2009 Correspondence Terry, Sherry Case Review Case Information 

Please review Application for disability 

2/1012009 2/1012009 Task Brannock, Susan [ Employee Contact ME-Independent Medical 

Examination 

Cdli EE to remind of IME on 2/1212009 at loam with Dr. Kutner, bring snack or lunch 

2/1012009 2/10/2009 Task zzTeta, Cristina Strouse, Irving (Dr.) 1 Provider Contact ’ Case Follow-Up 

clarify rtw (4 hours a day at home) - call provider for end date and if hours are to be worked at homej E-mail warksite to see if they will accommodate. 

2110/2009 211012009 Phone Call Brannock, Susan Spoke to IME Attempt to Schedule 

spoke to ee to remind of IMP on 2112/2009 at lOam with Dr. Kutner, bring snack or lunch 

2/1012009 2110/2009 Phone Call zzTeta, Cristina Employee Contact Case Follow-Up 

2110 cmt. Call placed to re, Informed ee that LTD nurse will try expidite review of LTD ppw sent in, Out can’t promise a certain date for review. 

2/1012009 211012009 Phone Call zzTeta, Cristina Strouse, Irving (Dr.) i Provider Contact Case Follow-Up 

2/I0 call. Call placed to AP, spoke to Lynne. Clarified RTW portion of LTD aps. "Sedentary work, 4 hours a day" should include the phrase "from home." (worksite unable to accommodate 

Page 38 of 105 

w 

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EE 

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Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 46 of 57 PageID: 480
(0 

Event Description DescriptIon Reference To 

(0 ci .oJ 

Employee Contact Case Follow-Up .g 

rstand why Reed Group may take up to 30 days to make a determination. States he is very E 

it feel he is ready to go back to work for even 4 hours at a time, unless it is working from 0 t 

two eat injections have not helped his back so far. C) < 

ors Case Review ]ME Independent Medical 

Examination 

Case Review LTD Application Review 

/os Vendor Contact IME-Independent Medical 

Examination 

Date Due Date Compltd Type Case Manager Person Contacted 

Notes 

211012009 2/1012009 Phone Call zzTeta, Cristina 

2110 coal. EE called in. Stated he was awake all night worrying I f he will qualify for LTD. Doesn’t I 

worried he is not approved for LTD. NCM went over [ME questions with ee and ltd questions. ee d 

home (which worksite will NOT accommodate). EE has appointment for third epi injection. States 

2/11/2009 211112009 Task zzMcRae, Megan Network, Exam Coort 

Follow up on allegatior as sent on 214/9 via email: on compla 

2/1012009 2/1112009 Task zzBlack, Karrie 

I TO APS 

2113/2009 2/1212009 Task zzMcRae, Megan Access, Medical 

Call for next-da 

2/12/2009 2/1212009 Task zzleta, Cristina Case Review Fax Review 

Please review attached medical into 

2/12/2009 2/12/2009 Task Decrescenzo, Rachael Case Review LTD Application 

Acknowledgement Letter 

Please send LTD Acknow Letter - recvd completed app on 2/11/09. (have aps now) Thx. 

2/1212009 2112/2009 Task zzTeta, Cristina Case Review Fax Review 

IME Provider Complaint Reporise 

2112/2009 2/12/2009 Phone Call ’ zzBrache, Emily Spoke to Case Follow-Up 

spoke to HR Holly who stated EE was supposed to RTW 213/09 and no one at the worksite has heard anything otherwise and EE’s supervisor has been trying to email someone at RG but hasn’t 

heard back yet. Advised currently EE is approved to 3/6/09 which is end of STD, and NCM is reviewin additional information to see if he needs LTD. - - 

2/12/2009 2/12/2009 Correspondence zzMcRae, Megan Access, Medical Evaluatins Correspondence IME Attendence Confirmation 

This is to inform you that we have verified that the above named claimant did show for his/her sch ed uled evaluation. We also reminded the physician to dictate his/her report ASAP and the report 

will he forwarded to you as soon as we receive it. 

Please do not hesitate to contact us if we maybe of further assistance to you. 

Access Medical Evaluations, Inc. 

(600) 375-0270 

FAY’ flA49c.1(47 

2/12/2009 2/1212009 Mail Merge Decrescenzo, Rachael Employee Contact LTD Application 

I IF) Annlir.ation Ack 

2/1212009 2112/2009 Correspondence zxTeta, Cristina Case Review Case Information 

2112 cunt. Reviewed ime complaint response. ME provider states - he has provided information as best he could based on what patient told him. He states patient added information in his critique 

of IME report that was not discussed during the exam. F - 

2112/2009 2112/2009 Case Review zzTeta, Cristina Quinones, Carmen M. (DF.) Medical Documentation Complete Medical - Initial 

2112 coil. Reviewed operative notes. ee had transformainal epi steroid injection on 2/9109 for lumbar disc herniation, lumbar raduculopatliy.Will flu in two weeks. EE had epi injection on 1/26. will 

f/u in two weeks. F 

Page 39 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 47 of 57 PageID: 481
WlJtHDate Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

212612009 2/1612009 Task zzMcRae, Megan Access, Medical Evaluatiqns Vendor Contact ME-Independent Medical 

- 

" Examination 

Call for final IME report from 211212009 at loam with Dr. Kutner 

2116/2009 2/16/2009 Correspondence zzMcRae, Megan Access, Medical Evaluations Correspondence IME Final Report Received 

Received _final _IME_report 

2117/2009 211712009 Phone Call zzTeta, Cristina I Employee Contact Case Follow-Up 

21I7 cmt. Ed called in to check status of NS ME Report. NCM informed ee that report was received a id tasked for review for 2118. EE continues to ask if he will be approved for LID. NCM 

informed ee that claim is still being reviewed. EE states Hartland PT faxed over 20 pages of PT notes on 2,12. NCM states fax not flied in case yet, if faxed over. 

2119/2009 2/19/2009 Task zzTeta, Cristina Case Review Case Management Plan 

UPDATE_NCP 

2/19/2009 2/1912009 Task zzleta, Crislina I Case Review Case Information 

monthly report 

211912009 2/19/2009 Task zzTeta, Cristina Case Review Fax Review 

IME Report 

211912009 2119/2009 Case Notes z,zTeta, Cristina Case Review ME-Independent Medical 

Examination 

2119 cmt. reviewed NP IME completed on 2112109. EE’s neurocognitive skill intact. EE has longstandirg dysthymic disorder which was exsacerbated by ongoing pain and physical limitations from 

his back and Achilles tendon conditions. Capable of psychologically and cognitively of performing and 8 hour per day job. IME provider recommended that ee receive individual weekly 

psychotherapy o a weekly basis using cognitive behavioral techniques which would focus on assisting him in coping with his physical condition and reducing his dysthymia and reducing 

anticipatory anxiety through development of more effective coping strategies. EE capable of returning to work without limitations or restrictions for cognitive and or psychological factors, 

2/19/2009 2/19/2009 Case Review zzTeta, Cristina Meeting Candidate STD Monthly Status Report 

2119/09 cmt 

180 day report 

Age: 

Job title: Sr Compliance Analyst 

1st Date of Disability: 918108 

Diagnosis: 

frmDisability Diagnoses 

Description 

Luthbosacral Spondylasis without Myelopathy; Arthritis; Osteoarthritis; Spondylarthritis 

Sprains and Strains of Other and Unspecified Parts of Back, Lumbar Spine 

Tenosyriovitis of Foot and Ankle 

Degeneration of Thoracic or Lumbar Intervertebral Disc 

Nature of surgery & dale: (op report should be available for reference) none 

Therapy: (date started, how often, type ex- pt, rehab, counseling, at, st. Notes should be available for reference) pt 

Diagnostic Testing: (mu, ring, biopsy, x-ray, ect. Results should be available for reference) xray 

Job Duties: (lifting #, standing requirements, freq Wrist movement, current class ect. JA should be available for reference) : EE works as a Sr. Complaint Analyst. JA notes frequent lifting up to 10 

Page 40 of 105 

N-

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0 

0 

ci 

Ct 

Qc( 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 48 of 57 PageID: 482
has heavy job class 

md response. NP IME completed - ee may Ow from a cognitive standpoint. 

hours a day starting 2/9/09. Worksite could not accommodate. 

Case Review/CM Plan Care Plan - Back Pain 

s; e.g. osteoarthritis, ankylosing spandylitis, congenital problems; scoliosis, instabilities; 

specific back pain,12113108 kam 

.tg ci oj 

writ 

10 C 

4- .- cE 

0< 

)ate Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

GO 

0 

0 

Notes 

Ibs, seldom up to 100 lbs. Seldom pushing, pulling, or reaching. Frequent sitting, occasional walking. 

Co-morbids: (overweight, cardiac, previous miscarriages; ect) 

Plan: 1) Has case exceeded the optimum duration? no 

2) If case has exceeded the optimum duration, please explain why. 

3) Explain case management plan: 

, )Has case been referred for review? (BMI, peer, ME, ect Include date and results) no 

1/20/09 kam IME done on 1/13109 ee may return to work but has some restrictions. [me faxed to red 

5)Note any additional treatment plans: Physical therapy, apt injections 

6) Has RTW been discussed including modified: Yes. Provider stated ee could work from 

Week IS: Ltd Application sent date: 1112 Received date: 214 

Ltd Roll Date: 318109 

!/19/2009 2/19/2009 Case Notes zzTeta, Cristina 

Care/Case Management Plan 2: i.ow , Back Injury/Disease 12113/00 kam 

Referral triggers: 

Lumbosacral sprain, intervetebral disc herniation, degenerative disease of the lower spine traumatic i 

spondylolisthesis, organic diseases; tumors, Joint syndromes; facet syndrome, muscle inflammation, 

Problem #1: Employees not achieving optimal health due to alteration in comfort: Pain 

Short Term Goal: Employee will report a decrease in discomfort from initial assessment and a plan will be established to address needs. Within three days of employee contact. 

Long Term Goal: 

Employee will return to pie-injury/illness pain free state within projected MDA guidelines. 1/1 9109 JP 

Interventions for short term goals: 

’DEducate the employee on possible complications and elimination of factors that precipitate p21n,2/1 

’OTeach employee methods to reduce pain before It becomes too severe both pharmacological and r 

breathing, repositioning, and divisional activities. 

’OContact the employees physician to confirm the treatment plan, diagnoses, expected recovery time 

’OFoIlow up call to member at defined interval 2119 cmt 

’GListen to employee in a non judgmental manner. 2/19 cunt 

01dentify barriers 2119 cmt 

oOffer assistance and support. 2119 cum 

Interventions for long term goals: 

oReview individual plan of action with the employee 2119 cmt 

’OAssess employee has made the needed changes in his/her medical treatment influencing disability 

OAssessment of functional ability/attainment of maximal functional ability. 

OTimeIy return to normal activities and employment. 

Page 41 of 105 

pharmacological methods for reducing pain/promoting comfort: back rubs, slow rhythmic 

expected MMI. 2/19 cmt 

1/19/09 JP 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 49 of 57 PageID: 483
Date Due Date Cornpltd Typo Case Manager Person Contacted Event Description Reference To 

Notes 

DAppropriate utilization of resources 

’DAvoidance of unnecessary surgery, hospitalization treatment and imaging studies. 

-[]Instruction on prevention of re-injury and decreased disability 1/19/09 JP 

flProvide knowledge on provision of quality, cost effective care 

[JEnsure employee has a plan in place to address barriers. 

[IProvide Human Resources with confidential reports and opportunities to improve your care and treatment plans, 

oReview individual plan of action with the employee and document in a written plan any accommodaions designed to promote timely and safe transition back to full work productivity. 

Problem #2: Employee is not achieving optimal health due to alteration in physical activity and inabilitS, to move purposefully within the environment. 

Short Term Goal: I 

I .[JEmployee will be knowledgeable of safety related issues due to activity limitations within three day of employee contact 

20Employee will demonstrate increased mobility/activity utilizing appropriate DM5 equipment within one week of injury/illness. 

(U 

w 

D C 

cE 

CD 

0cc 

Long Term Goal: 

Employee will progress to the highest level of mobility possible within limitations of diagnoses per 

Interventions for short term goals: - 

llEmployee will reduce or eliminate contributing factors by assess employees schedule. Allow rest p 

’DAssist to identify safety hazards in members environment or daily routine 

OEncourage person to note daily progress. 

-CEvaluate employees strength and degree of mobility through office notes or physical therapy notes 

-uWork with Physical therapist to obtain current treatment planlII9/09 JP 

liEvaluate for proper use of function and adaptive equipment 

[JEvaluate proper referral to PT,OT, or other 

-DEncourage relaxation training 

Interventions for long term goals: 

uAssess employee has made the needed changes in his/her medical treatment influencing disability 

DAssessment of functional ability/attainment of maximal functional ability. 

ulimely return to normal activities and employment.I119109 JP 

-ciplan and share necessity of learning outcomes with the employee. 

Ii]Appropriate utilization of resources 

-DAvoidance of unnecessary surgery, hospitalization, treatment and imaging studies. 

-[linstruction on prevention of re-injury and decreased disability 1119/09 JP 

-[IPrevention of possible complicationsl/19/09 JP 

-[]Ensure employee has a plan in place to address barriers. 

-OProvide Human Resources and doctor with confidential reports and opportunities to improve your c 

[JTo achieve consistent quality care by using nationally recognized clinical guidelines. 

Criteria for Case management closure 

-[iFunctional improvement 

-ORelief/ reduction of pain and symptoms 

oAppropriate utilization of resources and benefits 

uAvoidance of unnecessary surgery, hospitalization and surgery 

-[lEmployee satisfaction with medical care, case management services. 

[lEarIy return to work 

-DSafety issues have been identified 

-[JMedically cleared to return to work 

guidelines.1119109 JP 

between all activities. 1/19/09 .JP 

and treatment plans. 

Page 42 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 50 of 57 PageID: 484
Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

Notes 

Case Management Resources: 

I] 

http://www.highbeam.comllibraryl 

http://www.amedcanhealthways.com/regence/CSP/MemberlO2.asplClntODl &Prog=CE3P&Cat=Mbr&l 

Aetna low back manual 

Conte L. Timir B, The rehabilitation of persons with low back pain. Journal of Rehabiliation, April, 199 

The Medical Disability Advisor, Presley Reed, MD Fourth Edition 

littp:llwww.riicentral.com/careplans/plans/ai.html 

Praemer, A, Furner, 5, Rice, D, Musculoskeletal Conditions in the United States, 1992, American Ara 

Taylor V Deyo R, Cherkin D, Kreeulter W Freidlieb 0, The impact of managed care on the diagnosis 

1994. vol 91. 

’ci c 

IE E 

D ’0 

oct 

#2 

y of Orthopedic Surgeons. 

treatment of low back pain: a preimiary report, American Journal of Medical Quality 

2123/2009 2123/2009 Case Notes zzTeta, Cristina Case Review Job Analysis 

made job class - light 

2/23/2009 2/2312009 Correspondence zzTeta, Ciistina Rosado, Jose Employer Notification RTW 

From: Teta, Cristina 

Sent: Monday, February 23, 2009 12:12 PM 

To: ’JROSAD03@ITS.JNJ.COM’ 

Cc: kvaccaio@ocdusjnj.com 

Subject: Ralph VanDeventer 

I know that you are unable to accommodate having Mr. VanDeventer working 4 hours a day from 

at the worksite? Please let me know. 

Thank you, 

Cristina Teta 

Reed Group 

15 Tech Valley Drive 

East Greenbush, NY 12061 

866.829.8861 

518.880,66IOFAX 

cteta@rgl.net 

Is there a possibility of having Mr. VanDeventer working a sedentary position 4 hours a day 

Page 43 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 51 of 57 PageID: 485
Date Due Date Conipltd Type Case Manager Person Cont. 

Notes 

2/23/2009 2123/2009 Correspondence zzTeta, Cristina Rosado, Jose 

From: Rosado, JosØ Luis [000US] [mailto:JROSAD03@itsjnj.com] 

Sent: Monday, February 23, 2009 12:20 PM 

To: Tea, Cristina 

Cc: Vaccaro, Kathryn [OCDUS] 

Subject: RE: Ralph Vanoeventer 

Yes, we can make that accomodation. 

-----Original Message 

From: Teta, Cristina [mailto:ctela@rgLnetj 

Sent: Monday, February 23, 2009 12:12 PM 

To: Rosado, JosØ Luis [OCDUS] 

Cc: Vaccaro, Kathryn [OCDUS] 

Subject: Ralph Vanfleventer 

know that you are unable to accommodate having Mr. VanDeventer working 4 hours a day from 

at the worksite7 Please let me know. 

Thank you, 

Cristina Teta 

Reed Group 

15 Tech Valley Drive 

East Greenhush, NY 12061 

866.829.8861 

518.880.66 1 OFAX 

cteta@ rgl. net 

http://www.rgl.net 

Event Description 

Employer Contact 

Reference To 

RTW 

nib 

C 

0) 

’C C 

9- cE 

C) t 

0cc 

Is there a possibility of having Mr. VanDeventer working a sedentary position 4 hours a day 

This e-mail and any attachments may be confidential or legally privileged. If you received this me in error or are not the intended recipient, you should destroy the e-mail message and any 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any ation contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

you for your cooperation. 

Page 44 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 52 of 57 PageID: 486
Date Due Date Compltd Typo Case Manager - Person Event Description Reference To 

Notes 

2/23/2009 2/2312009 Correspondence zzleta, Cristina Strouse, Irving (DL) Provider Contact RTW 

2123 cmt. Faxed copy of rtw ,form to Dr. Strouse, asked if ee could work 4 hours a day sedentary positi4m from worksite. 

2123/2009 2/23/2009 Correspondence zzTeta, Cristina Strouse, Irving (Dr.) Provider Contact RTW 

2/23 cmL Rtw form and cover letter asking if Ce could rtw 4 hours a day sedentary work faxed to provker. 

2/25/2009 212412009 Task zzTela, Cristina I Case Review Fax Review 

Please review attached RTW form 

’J2412009 2/24/2009 Case Review zzTeta, Cristina Strauss, Irving (Dr.) Case Review RTW 

2/24 cart. Reviewed rtw note dated 2/23/09. FE may return to work on 312109, Sedentary position, working 4 hours per day. This restriction will last until 416109. 

7124/2009 2/2412009 Correspondence zzleta, Cristina Rosado, Jose Employer Notification RTW 

2124 cmt. E-mail sent to supervisor requesting accommodations of restrictions.From: Tote, Cristina 

Sent: Tuesday, February 24, 2009 12:25 PM 

To: ’JROSADO3@ITS.JNJ.COM ’ 

Cc: ’kvaccaroocdus.jnj.com’ I 

Subject: Ralph R Van Deventer Jr 

Jose, 

I received an updated return to work form for Ralph Van Deventer today. His physician is clearing him o work 4 hours a day (from the worksite), sedentary position (sitting most of time, brief 

periods walking/standing, may lift up to 10 lbs occasionally). This restriction will last until 4/6/09. Per yqur e-mail dated 2123, you indicated you could approve this accommodation. Now that I have 

the official return to work note from the doctor, would you please respond to this e-mail indicating that you are accommodating this restriction. Once I have your reply, I will contact Ralph to let him 

know he is cleared to return to work. He is aware that he must report to Health Services. 

Thank you, 

Cristina Teta 

Reed Group 

15 Tech Valley Drive 

East Greenhush, NY 12061 

866.829,0861 

513.880.661 OFAX 

cteta'rgl.net 

http://www.rgl.net 

.! ci 

0 C 

’ E 

1 

Page 45 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 53 of 57 PageID: 487
Date Due Data Conipltd Typo Case Manager Person Contacted Event Description Reference To 

Notes 12 ci O) 

D C 

This e-mail and any attachments may be confidential or legally privileged. If you received this messagd in error or are not the intended recipient, you should destroy the e-mail message and any 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any information contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

you for your cooperation, I 

O 13 

(3-c 

//2512009 212412009 Task zzTeta, Cristina Case Review Case Follow-Up 

look for resoonse to e-mail sent on 2124109. Able to accommodate restrictions? 

212412009 2/24/2009 Correspondence zzTeta, Cristina Rosado, Jose 

From: Rosario, JosØ Luis [OCDUS] fmailto:JROSAD03@its.jnj.corn] 

Sent: Tuesday, February 24, 2009 12:33 PM 

To: Leta, Cristina 

Cc: Pericone, Anne tVRXUSI 

Subject: Re: Ralph R Van Deventer Jr 

Ok. Please advise him. 

Anne, we need to schedule meeting with HR and Nora. 

Employer Notification RTW 

From: Teta, Cnistina 

To: Rosado, JosØ Luis [OCDUS] 

Cc: Vaccaro, Kathryn [OCOUS] 

Sent: Too Feb 24 12:25:25 2009 

Subject: Ralph R Van Deventer Jr 

Jose, 

I received an updated return to work form for Ralph Van Deventer today. His physician is clearing him 

periods walking/standing, may lift lip to 10 lbs occasionally). This restriction will last until 4/6109, Per y 

the official return to work note from the doctor, would you please respond to this e-mail indicating that 

know he is cleared to return to work. He is aware that he must report to Health Services. 

Thank you, 

Cristina Teta 

Reed Group 

15 Tech Valley Drive 

East Greenbush, NY 12061 

866.829,8861 

518 080.6610FAX 

Page 46 of 105 

,work 4 hours a day (from the worksite), sedentary position (sitting most of time, brief 

ire-mail dated 2123, you indicated you could approve this accommodation. Now that I have 

in are accommodating this restriction, Once I have your reply, I will contact Ralph to let him 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 54 of 57 PageID: 488
LU 

C 

Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 0 

Notes 

ctetargI.net 

0) 0 

0) 

t C 

’?E E 6 -0 

0< 

Iittp://www,rgknet 

This e-mail and any attachments may be confidential or legally privileged. If you received this message in error or are not the intended recipient, you should destroy the e-mail message and any 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any info rration contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

Von for your cooperation. 

2/2412009 212412009 Phone Call zzTeta, Cristina Employee Contact RD/V 

2/24 cmt. Call placed to ee, Informed ee that he is cleared to rtw on 3/2109 for 4 hours a day until 416I09, at which time he would be full time status. He will be paid his salary for the 4 hours a day 

he is at work and then 60% LTD for the 4 hours he is not workino. EE will report to Health Services prifr to returning to work. 

2/2612009 212612009 Correspondence zzTeta, Cristina Vaccaro ***, Kathy 

From: Vaccaro, Kathryn [OCDUS] (mallto:KVaccaroits.jnj.comj 

Sent: Thursday, February 26, 2009 11:00 AM 

To: Teta, Cristina 

Subject: RE: Ralph VanDeventer 

Is his rtw date confirmed? 

-----Original Message-- 

From: Leta, Cristina [mailto:ctetarg].net] 

Sent: Monday, February 23, 2009 12:12 PM 

To: Rosado, JosØ Luis [OCDUS} 

Cc: Vaccaro, Kathryn [OCDUSI 

Subject: Ralph VanDeventer 

I know that you are unable to accommodate having Mr. VanDeventer working 4 hours a day from 

at the worksite? Please let me know. 

Thank yob, 

Cristina Leta 

Reed Group 

15 Tech Valley Drive 

East Greenbush, NY 12061 

866.829.8861 

Page 47 of 105 

Employer Contact RTW 

Is there a possibility of having Mr. Vanoeventer working a sedentary position 4 hours a day 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 55 of 57 PageID: 489
Date Due Date Compltd Type Case Manager Person Contacted 

Notes 

518.880,66I0FAX 

cteta@rgl.net 

Event Description Reference To * 

12 ci 

0) 

TJ C 

i F 

0 t 

QcC 

http:fIw.rgLnet 

This e-mail and arty attachments may be confidential or legally privileged. If you received this messagd in error or are not the intended recipient, you should destroy the e-mail message and any 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any infornation contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

you for your cooperation. 

1/2612009 212612009 Correspondence zzTeta, Cristina Rosado, Jose 

From: Teta, Cristina 

Sent: Thursday, February 26, 2009 12:51 PM 

To: ’JROSADO3@ITS.JNJ.COM 

Cc: ’kvaccaro@ocdusjnj.com ’ 

Subject: Ralph R Van Deventer Jr 

Please be advised Mr. Van Deventer is cleared to return to work on 312/09, four hours a day at the 

lbs occasionally). This restriction will last until 416109. Thank you for your response on 2/24109 mdi 

Health Services. 

Thank you, 

Cristina Teta 

Reed Group 

15 Tech Valley Drive 

East Greenbush, NY 12061 

8668298861 

5113 880. 66 IOFAX 

cteta@rgl.net 

http://www.rgl.net 

Employer Notification R1W 

site, sedentary position (sitting most of time, brief periods walking/standing, may lift up to 10 

Your accommodation of these restrictions. Mr. Van Deventer has been advised to report to 

Page 48 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 56 of 57 PageID: 490
Date Due Date Compltd Type Case Manager Person Contacted Event Description Reference To 

(0 6 a) 

13 C 

E E 

0 -D 0< 

This e-mail and any attachments may be confidential or legally privileged. If you received this messagb in error or are not the intended recipient, you should destroy the e-mail message and any 

attachments or copies, and you are prohibited from retaining, distributing disclosing or using any inforriation contained herein. Please inform us of the erroneous delivery by return e-mail. Thank 

you for your cooperation. 

212612009 2/2612009 Phone Call zzTeta, Cristina Message Received Case Follow-Up 

2126 crnt. FE left _message Needs rtw form faxed to his home fax number. (Reverse Auth is On file.) 

2126/2009 212612009 Phone Call zzTeta, Cristina Employee Contact Case Follow-Up 

Notes 

2126 cmt. Spoke to spouse. Her 41 year old brother died of head attack last night. Spouse stating 

Mary Anne is spouse. 

2/26/2009 2/26/2009 Correspondence zzleta, Cristina Rosado, Jose 

From: Rosado, JosØ Lois [OCDUS] [mailto:JROSAD03@its.jnj.coml 

Sent: Thursday, February 26, 2009 2:00 PM 

To: Teta, Cristina 

Cc: Vaccaro, Kathryn IOCDUS]: Pericone, Anne [VEUKUS] 

Subject: RE: Ralph R Van Deventer Jr 

Importance: High 

Cristina, 

Can you advise Ralph to come in later in the day on march 2. He cannot begin work until he meets 

Original Message 

From: Teta, Cristina (mailto:ctetargI.netj 

Sent: Thursday, February 26, 2009 12:51 PM 

To: Rosado, JosØ Luis [OCDUS] 

Cc: Vaccaro, Kathryn [OCDUS] 

Subject: Ralph R Van Deventer Jr 

Please be advised Mr. Van Deventer is cleared to return to work on 3/2/09 four hours a day at the 

lbs occasionally). This restriction will last until 416/09. Thank you for your response on 2124109 indh 

Health Services. 

Thank you, 

Cristiria Teta 

Reed Group 

16 Tech Valley Drive 

East tsreenhush, NY 12061 

back is hurting him. Ee is afraid to rtw because of pain in back. Has four foster children. 

Employer Notification RTW 

us and also before retraining on procedures. 

ite, sedentary position (sitting most of time, brief periods walking/standing, may lift up to 10 

your accommodation of these restrictions. Mr. Van Deventer has been advised to report to 

Page 49 of 105 

Case 3:10-cv-06344-PGS-DEA Document 14-7 Filed 05/13/11 Page 57 of 57 PageID: 491