Six Things To Do When An Injury Might Be A Pre Existing Condition

July 28, 2009 By // by Robert Elliott, J.D. Leave a Comment

Causality: When Diagnosed Injury was Pre-existing

Following a work-related incident, a good employer makes sure the injured employee is seen by medical professionals; often more than one type; and often over an extended period of time.

Since it is common practice for people to delay going to the doctor for symptoms they are experiencing, there are times a condition is diagnosed for the first time following a work-related accident.

For example, an MRI following a head injury could turn up a tumor – clearly the tumor is not a result of the work accident and, therefore, not part of the obligation of your workers’ compensation program.

Determining causality can be cleared up in an email from the injury coordinator to the adjustor.

When a physician reviews the file and speaks to the employee’s treating specialist, the two doctors can discuss the medical issues peer-to-peer. The result is very credible evidence the injury is or is not related to work.

Workers’ Comp Kit suggests the following email communication:

Be sure to include claim number and all relevant addresses and contact information on the letter.
Explain the company’s medical advisor has reviewed the employee’s medical records.
Explain the accident as well as the recently diagnosed condition.
Show how physicians determined one is not the result of the other.
Let the adjustor know these physicians’ findings will arrive soon. (workersxzcompxzkit)
Explain you will contact the adjustor once they have time to review the notes to be sure you have sufficient evidence to deny the claim.