• Menu
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

  • About
  • Contact
  • Privacy
 
Paradigm

Amaxx Workers Comp Blog

Reduce Workers Compensation Costs By 20-50%

Header Right

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login

Mobile Menu

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login
  • About
  • Contact
  • Privacy
You are here: Home / Claim Management / 4 Things to Consider in Complex Work Comp Causation Cases

4 Things to Consider in Complex Work Comp Causation Cases

September 21, 2017 By //  by Senior Editor

work comp causation Members of the claims management team are challenged daily to run an effective operation. One of these issues claim handlers confront are questions of medical causation before admitting primary liability on a workers’ compensation claim. Unfortunately, most members of the claims management team do not have a medical degree, but they do have many resources at their disposal to meet these challenges and make even complex decisions with certainty.

This post is one in a 3-part series:

  • Course and Scope of Employment: Questions of Compensability
  • 4 Things to Consider in Complex Work Comp Causation Cases
  • Donald Trump, Hillary Clinton, and Workers Comp Medical Decisions

To Admit or Deny Primary Liability

Questions of medical liability for a work injury are often more complex than those that involve a “legal” basis for denial. When reviewing questions of medical causation, claim handlers need to consider the following issues:

  • Evidence of clinical medical findings to substantiate a work injury;
  • Evidence of the requisite workplace exposure—which are often complicated by claims or repetitive use allegations; and
  • Medical literature that connects or links the work activity to the alleged injury.
    Click Link to Access Free PDF Download

    “How Do I Get My Adjusters To Follow My Account Handling Instructions?”

In many instances, claims handlers are left to rely on training, experience and gut instinct to make decisions. Time is of the essence given statutory parameters following receipt of the First Report of Injury. Failure to do so can result in admissions against interest and/or penalties.

4 Things to Consider in Complex Work Comp Causation Cases

Members of the claims management team need to be proactive when it comes to admitting or denying a workers’ compensation claim that boils down to issues concerning medical causation. There are important steps one can take to make a reasonable and well-informed decision.

  • Investigate the mechanism of injury: This consideration includes the question of “how” an injury occurred. The claim handler will have medical records that detail how the injury took place. In other instances, they may have the opportunity to conduct a more in-depth investigation. This can include a recorded statement from the injured worker or witnesses.
  • Determine the exact medical diagnosis: This includes obtaining as many medical records as possible immediately following the work injury. This starts with learning where the employee received post-injury care and the names of prior medical providers. In many instances, state and federal privacy laws allow claim handlers to receive medical records without a signed authorization.
  • Review all diagnostic tests and studies: Reviewing the reports from medical studies can provide insight into the origin of an injury. Examples of this include injuries to the upper extremities, shoulder areas and cervical spine. A review of EMGs, CT scans and MRI can narrow the point of injury and its origin.
  • Roundtable with the claims team: This is a value resource to review the facts and question the plausibility of a claim. Roundtable sessions with a claims management team are important for many reasons. This includes the ability of claim handlers to learn from each other’s experience and plot claim strategy. It can also be an opportunity to poke holes in the employee’s version of events and plan a defense.

    FREE DOWNLOAD: “How Do I Get My Adjusters To Follow My Account Handling Instructions?”

Battle of the Medical Experts

In many litigated claims involving injury causation, there is a “battle of the experts.” While the employee always carries the burden of proof, many jurisdictions view the evidence in a light most favorable to the employee. The result in the need to provide the medical expert with as much information as possible prior to the adverse examination. A well written IME report and excellent bedside manner for courtroom testimony is a must.

Conclusions

In every workers’ compensation claim, a strong defense starts with the claim handler working the file. This requires that person to use their skills and resources to conduct a diligent investigation and examine the important issue of medical causation. Claim handlers have many resources. By using them, they can position their file load for success and reduce costs in their workers’ compensation program.

Michael Stack - Amaxx

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

FREE DOWNLOAD: “How Do I Get My Adjusters To Follow My Account Handling Instructions?”

Filed Under: Claim Management

Related Articles

Appreciation in Workers’ Compensation

Appreciation in Workers’ Compensation

You’re Fired! Work Comp and Retaliation Claims

You’re Fired! Work Comp and Retaliation Claims

Select the Workers’ Comp Claims Administrator

Select the Workers’ Comp Claims Administrator

File Reviews: The Who, What, When, Where, and How to Conduct One

File Reviews: The Who, What, When, Where, and How to Conduct One

Develop Relationships to Reduce Work Comp Costs

Develop Relationships to Reduce Work Comp Costs

Is an Injured Employee’s Transitional Duty Work at a Charity Tax Deductible?

Is an Injured Employee’s Transitional Duty Work at a Charity Tax Deductible?

4 Strategies to Dispute a Workers’ Compensation Claim

4 Strategies to Dispute a Workers’ Compensation Claim

The Importance Of Employer’s Injury Investigation

The Importance Of Employer’s Injury Investigation

Effective Management of Service Providers to Reduce Workers’ Comp Costs

Effective Management of Service Providers to Reduce Workers’ Comp Costs

Reimage and Humanize Work Comp to Reduce Costs

Reimage and Humanize Work Comp to Reduce Costs

Biomedical vs Biopsychosocial – Thanksgiving Edition

Biomedical vs Biopsychosocial – Thanksgiving Edition

5 Circumstances To Review Work Comp Claim Subrogation

5 Circumstances To Review Work Comp Claim Subrogation

Free Download

How Do I Get My Adjusters To Follow My Account Handling Instructions? - FREE Download Click Here Now!

Train to Succeed

BECOME CERTIFIED IN WORKERS’ COMPENSATION

Proven Course Catalog & WC Toolbox Give You The Power To Achieve Lower Costs and Better Injured Worker Outcomes

VISIT WORKERS' COMP TRAINING CENTER

Previous Post: « 7 Ways Structured Settlements Are Advantageous — Regardless of Interest Rates
Next Post: President Trump: How NOT To Deal with Unions in Workers’ Comp »

Primary Sidebar

FREE DOWNLOAD

How Do I Get My Adjusters To Follow My Account Handling Instructions? - FREE Download Click Here Now!

Our Sponsors

ARCADIA - Enhancing Settlement Outcomes

The Structured Settlements Company
 

Catastrophic and Risk Solutions, Case Management Solutions, and Specialty Networks
 

Post-Settlement Administration
 

Medcor

Injury Triage, Onsite Clinics

Read Our Award-Winning Blog

Blog Categories

Search Our Archive

Subscribe to Our FREE Newsletter

Return-to-Work Essentials

Footer

Search Our Archive

Search our continually growing archive of over 2500 articles about Workers' Comp issues.

Quiclinks

  • Calculators
  • Terms & Abbreviations
  • Glossary of WC Premium Terms
  • WC Resources
  • Best Practices
  • Industries
  • Return-to-Work Essentials

RSS Recent Blog Posts

  • Five Things to Include in Your Workers’ Comp Communication Policy
  • An Advocacy Approach in Claims Handling
  • Appreciation in Workers’ Compensation
SUBSCRIBE TO OUR FEE NEWSLETTER
Let Us Help You Stomp Down the High Cost of Workers' Comp!
Top of Page ↑
  • Home
  • Training Center
  • Search
  • Membership
  • Products
  • Blog
  • About
  • Contact
  • Subscribe
  • Login
Copyright © 2022 Amaxx, LLC. All Rights Reserved. · Privacy Policy / Legal Notice