Many adjusters will use surveillance on the cases to get an actual glimpse of what the claimant is up to on a day-to-day basis. Sometimes this can be helpful to the defense of the claim and other times it can yield no real pertinent results towards the actions on a case.
But you must know what to look for, and how to use these results to your advantage, to assist in the defense of a claim. [WCx]
Look for consistency
Are canes and crutches being used? Are they being used correctly?
Sticking with the leg injury theme, if a cane or crutches are prescribed, it is always good to see if the person is actually using them, and using them correctly. There are countless cases where a cane is prescribed and, if the person is actually using it, it is used incorrectly. Sometimes the cane is carried when walking. If an attempt is made to use the cane, it is used incorrectly meaning not in a way helpful to the injury. Or even better, after leaving an IME appointment, the cane is tossed into back of the car and when surveillance people tail the worker back home, the cane is not used at any other time. Again, this is helpful to the defense.
Note: Ask the IME doctor before the appointment to examine the cane or crutches for wear and tear. If the person is indeed using it all the time, the bottoms will be worn, and the handle may have some evidence of wear. If the medical device appears new and unused, and the worker is saying it is being constantly used, then there is some good ammunition to use in the defense, or at least use this to base some additional investigation.
Is the claimant breaking the medical restrictions on a regular basis?
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
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