Prior Medical Records are Critical for Workers Comp Claim Defense

When a worker is injured, there is no way to tell of the past medical injury. Ask if there is a prior injury history to this specific body part, but whether this person is honest or not is really the question. This can change if the worker has a workers comp history of prior injury to the back or shoulder. For example, if the current injury is to the back or shoulder, the injured party is not going to share a great deal about any other past medical issue.

 

 

Being able to locate prior medical treatment records for the current injury in question is extremely important. In fact, this can affect the overall compensability of the claim. Typically the common cause of a delay in accepting or denying a workers comp claim will have do to with the adjuster trying to locate past medical records. Here are some tips to try to speed up the process. (WCxKit)

 

 

  1. Do a pre-employment physical

 

If the work is medium to heavy in nature, it is very important to screen the new hires with a pre-employment physical. Using a qualified physician, educated in the work duties is also essential. Upon examination, the physician will be able to determine if this worker is able to do this specific job day in and day out. The physician also looks for prior surgical scars that can indicate a prior injury needing surgical repair. That alone can save the worker from being exposed to future injury at the workplace. Safety is the most important thing to provide the workers, and the last thing to do is place them in a job they cannot do. With a current slow economy, some workers have been out of work for several months, leading to a general deconditioning. These workers will not be volunteering any information  that they cannot do the job they were hired for, so protect the human capital investment with a pre-employment physical.

 

 

  1. Have the new worker complete a medical history sheet before being placed in a specific job

 

Many employers keep a medical history sheet in the workers personnel files, containing primary doctor contact info, along with a sheet the worker completed listing any prior surgeries or injuries. Again whether or not workers are honest is up to the workers. This is only depending on circumstances. But if a shoulder injury occurs and the adjuster finds out there was a prior shoulder injury before the employment, and the worker did not indicate this on the medical history sheet,  try and use this to defend having to pick up the claim.

 

 

  1. Be sure the adjusters on the account send out a request for a signed medical release

 

One of the reasons the compensability is delayed on a new workers comp claim is due to the adjuster trying to locate prior medical records. If an ISO search is done and it shows the worker had a prior auto accident or workers comp claim, the adjuster should be contacting the carrier for information on the claim. Most carriers will not volunteer this information without a signed release. Also if the adjuster tries to obtain past medical records, most providers will not send this information without a signed release, thanks to HIPPA privacy laws.

 

It is pretty standard these days when a new injury occurs involving lost time from work, a request for a medical release, along with the contact letter is sent to the claimant at the start of the claim. The employer cannot force the claimant to sign, but non-compliance is not going to help in the long run and may only bolster the fact there is something in the medical past being hidden.

 

 

  1.  If past medical records are located, do an IME or peer review for compensability

 

Should past medical records be found relating to the current injury, generally an adjuster cannot make the causal relation decision on the compensability of the claim. This will have to be done with an IME or with a peer review by a physician. When completing this report, be sure to have as many of the past medical records as possible, along with the facts of the past prior injury. This will ensure that the decision the IME doctor makes is the correct one when it comes to the compensability of the claim. Also be sure to choose the correct physician specialty for making this decision. Orthopedic surgeons or neurosurgeons are the most often chosen specialties for these scenarios. Draft a comprehensive cover letter, and give the doctor direct questions to answer about how this current injury can relate to the work, and not to anything prior.

 

 

  1. Use an outside vendor to help locate medical history issues

 

If all else fails at a dead end, consider using an outside vendor to do sweeps for medical records. A pharmacy sweep will show which doctor prescribed the medicine, and that is where to send the signed medical release looking for past records. If the worker was prescribed an opiate drug in the past, consider that a red flag for a decently serious injury.

 

The same is true for a MRI sweep. If a worker has had past MRIs on the back or neck, they must have sustained a serious injury for needing that type of test to be completed. Hospital sweeps can also be done, to see if the worker had any treatment in ER department due to an injury either inside or out of the workplace. (WCxKit)

 

 

Summary

The importance of past medical records cannot be ignored. ISO searches and medical sweeps should be done on all claims deemed to be questionable, or on all claims in general that will require surgery or extended lost time away from work. Often times hidden in these medical records are a key to denying a claim that is not the responsibility to cover in the first place. So make it a standard part of the claims practice, and put the time in needed to do a proper medical background investigation. The end result could save tens of thousands of dollars in claims expense.

 

 

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.

 

 

WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com

 

WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE:  Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

Quick Tip: Keep Excellent Workers Compensation Records

Document, Document, Document
Carriers preach the importance of documentation in claim files using this pithy saying: ” If it is not documented, it did not happen.” The same should be true for every employer. Risk management or safety team members must properly document everything. This includes tracking numbers and incidents, recording safety problems, and keeping a close watch on injuries and incidents on the work floor.

 

Why record keeping is important
All workers arrive on the job with various physical issues related to their personal life. Perhaps the worker did a lot of yard work over the weekend and is sore. Maybe the employee fell shoveling snow and has a back injury. Maybe personal turmoil is affecting safety and work. Regardless of cause, it is important to keep proper records on everything heard on the job floor. No one can recall every single detail of a day, so writing it down is critical to document the situation.

 

When talking to employers, I ask the employer how aware they are of an employee’s personal life. Some answer that question by saying little to no social contact with employees. Other employers will report being friends with coworkers and socializing on a regular basis. Some are right in the middle, reporting casual exchanges in the hallway or break room but not really knowing the employee.
The medical worlds of insurance are interwoven between personal injuries and workers compensation injuries. Some workers have a good combination of both. Some workers never take any time off for a medical condition, whereas others will  be off of work frequently for some reason or another.
Many HR people have access to personal medical leave papers. The importance of keeping records shows itself when the time comes and they are needed. If an employee had a knee surgery last year then suddenly claims to injure the same knee at work, a review of personnel files may show the alleged knee injury is not work related. But if the records do not exist, then there is no way to question the claim.
When filing the compensation claim for the knee injury, the adjuster calls and probes about any other past injuries. If the employer is only able to give a vague account of a past injury, the adjuster lacks information to judge the claims compensability. If the claimant does not bring it up to the adjuster, and there are no records as to the employee’s medical leave, there is no way to prove a pre-existing knee injury is present. So with any injury, it is important to keep proper records in every  personnel file. No matter the reason for the medical leave, documentation with as much information as possible must be gathered at the time of medical leave. This will help in the future should an issue like the one described happen. The impact documentation has on a workers comp claim can be priceless, in that the employer may not pay workers comp benefits.
Document, document, document …. oh, and write it all down.

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 website 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%. www.WCManual.com
Visit
www.LowerWC.com for more information for cost saving hints and tips. Contact: RShafer@ReduceYourWorkersComp.com.
WORKERS COMP GUIDEBOOK:  www.WCManual.com 

 

WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

10 Red Flags in Workers Comp Psychiatric Evaluations

A worker is injured, anxious, and depressed. Is his or her emotional condition caused by the injury? Is the psychological condition – separate from any physical injury – causing any impairment? Is treatment needed and, if so, what kind? Can the worker return to full duty in the same environment the injury occurred? If not, why not?

 

 

These questions, and many others, are often faced by attorneys and insurance personnel in workplace injury cases involving claims of emotional distress. Such claims often prove both challenging and controversial, as the interplay of pre-existing conditions, injury, somatization, motivation, and intercurrent stressors can be difficult to unravel. In some areas of medicine, diagnostic tests can point convincingly to causation, such as in the case of a crush injury, fracture, or disc herniation. In contrast, psychiatry lacks even a definitive diagnostic test, much less one that provides objective indicators of etiology. The mental health examiner must weigh a host of potential contributing factors in arriving at opinion about causation. Then, it is on to impairment, where the line between capacity and motivation is blurred even more than in cases of physical injury. (WCxKit)

 

A full discussion on the nature and causes of psychiatric conditions in workers compensation far exceeds the current forum, as would a detailed description of the appropriate methods for evaluating and diagnosing these conditions.

 

The following 10 “red flags” are common problems seen in evaluations, not only from treating providers but from “expert” examiners as well, and are suggested as a quick reference guide:

 

  1. Insufficient time spentwith claimant: How long does it take to sort out the many factors needed to determine causation, impairment, and treatment needs? Anything under 1.5 to 2.0 hours is likely inadequate. After all, forensic experts in high profile criminal cases spend dozens, if not hundreds, of hours getting to know and understand the defendant. The stakes in WC cases, though different, are also high. The information needed to render a well-informed opinion cannot be obtained in 15 or 20 minutes.

 

 

  1. Insufficient record review:Have both medical and mental health records been reviewed? So often we see records from medical providers noting some symptoms of depression or anxiety, and causally (and often casually!) attributing the symptoms to the workplace injury or event. Mental health records also frequently include diagnoses and causal imputation. A good evaluation report must not only note these records but must evaluate their basis and value. Also, request for and review of records preceding the injury is critical.

 

 

  1. Failure to identify pre-injury, peri-injury, and post-injury stressors: It is critical that all other possible contributing stressors be detailed and accounted for. In Connecticut, where I practice, a psychiatric condition is only compensable under WC if it arises out of a physical injury. For example, if a worker loses a limb in a construction accident and develops depression secondary to the disabling injury, that clearly falls under the purview of the law. But often we see claims for emotional distress arising more out of the stressful workplace environment than in response to the actual injury. Not infrequently, a minor physical injury is incidental, and it is the stressful workplace event or context that is truly the substantial causal element. Other life stressors, including financial and social consequences of the workplace injury, must also be accounted for. Finally, prior life stressors or traumas (e.g., a prior history of abuse or injury) must be assessed, as these often represent a predisposing vulnerability factor and can be associated with both pre-existing symptoms and/or impairments.

 

 

  1. Lack of malingering assessment:There are several widely used and standardized assessment instruments for assessing symptoms exaggeration or malingering (they will not be listed here to protect the integrity of the tests). A thorough assessment of malingering integrates results of these measures with observation, consistency of records, assessment of motivational factors, and collateral information to make a determination about the validity of the claimant’s self-report. Any evaluation in a WC case that does not address this issue thoroughly should be cause for concern.

 

 

  1. Psychological testing:Has psychological testing been conducted? Is the rationale for the tests used provided? It is difficult to determine the appropriate use and interpretation of test results without direct consultation with a psychologist. For starters, however, it is important to note that results of many objective tests are only valid when viewed in aggregate: Individual responses to individual test questions are not valid for interpretation, and should never be reported as such.

 

 

  1. No family history:What is the claimant’s genetic and environmental vulnerability? Providers and examiners frequently omit such history in WC cases in an effort to protect the individual’s privacy. However, defensible assessment of causation cannot be done without knowledge of the family history.

 

 

  1. Mental status exam:This section appears in most psychiatric reports, with the intent of describing what is observed about the claimant on examination. What is his or her apparent emotional state? Is he forthcoming with information, or guarded and defensive? Importantly, do the observed emotional state and the reported symptoms and function match?

 

 

  1. Where is the beef?A description of symptoms supporting the diagnosis is critical, and these symptoms should accord with the criteria set forth in the DSM-IV-TR. Reports should also include a detailed description of day-to-day function. Can the claimant socialize, travel, engage in hobbies, or do housework?

 

 

  1. Differential diagnosis.Is it really post-traumatic stress disorder (PTSD)? The diagnosis of PTSD is the sin qua non of psychic injury arising out of workplace events. Why? Because it is the only psychiatric diagnosis that denotes causation. However, many workplace injuries and their circumstances do not truly meet what is referred to as Criterion A: that is, a stressor must involve not only “threat to the physical integrity of self or others,” but the individual’s emotional reaction at the time must include “intense fear, helplessness, or horror.” Caution is urged in accepting diagnoses of PTSD caused by routine events or injuries.

 

 

  1. Misguided Permanent Partial Disability (PPD) ratings: Mental health examiners rarely use the AMA Guides to the Evaluation of Permanent Impairment, instead relying on the traditional multiaxial diagnostic system per DSM. The only Axis that reflects impairment is Axis V, the Global Assessment of Functioning or GAF. However, the GAF scale reflects symptom severity and/or impairment, and in the case of desynchrony between the two the lower score is to be used. Thus, an individual who is functioning well despite severe symptoms may warrant a low GAF score that is not reflective of actual impairment in either social or occupational function. If asked specifically to use the Guides, mental health examiners must be aware that the Guides 6th edition has a new system that uses the median of three distinct measures to calculate a PPD rating. The process is not subjective yet is rarely used. In a recent WC evaluation, I reviewed a claimant’s file in which the treating provider had given a 40 percent PPD rating for mental health. In contrast, my evaluation following the AMA Guides formula yielded a 10 percent rating, of which I concluded about half was related to the workplace incident. Bottom line: impairment ratings are usually subjective and often unreliable. Beware of any GAF rating under 40, unless the person is gravely disabled and on the verge of hospitalization, this is likely to be an inflated rating of severity.(WCxKit)

 

These “red flags” provide a thumbnail checklist, but fall well short of the knowledge required to fully understand and evaluate reports and opinions in this field. Attorneys and insurance adjusters would benefit from additional education on the nature of mental illness and the challenges inherent in determining causation and impairment in these cases.

 

Author: Dr. Andrew Meisler is a clinical and forensic psychologist in practice in Hartford, CT, with faculty appointments at the UConn School of Medicine and the Yale University School of Medicine. He serves as independent examiner for attorneys and insurers, provides consultation to the office of the Attorney General in workers compensation claims, and has extensive deposition and trial experience in state and federal court as well as at the CHRO and Workers Compensation Commission. Contact at: andrewmeisler@gmail.com or phone (860) 236-8087, #108.

 


Our WC Book: 
http://corner.advisen.com/partners_wctoolkit_book.html

WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:  http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

 

OSHA Record Keeping for Work-Related Injuries 101

In addition to reporting all work-related injury claims to the workers' compensation claims office, there is additional paperwork to be completed. Most private employers with 10 or more employees are required by the Occupational Safety and Health Administration (OSHA) to keep a log of work-related injuries and illness, commonly known as Form 300. [Some “low risk” business such as insurance offices, real estate offices and small retail outlets are exempt].
 
 
Each Location:
A Form 300 has to be completed for each separate physical location where you have employees for at least one year. The physical location also includes employees who are assigned to a location but who are routinely located elsewhere (think truck drivers or traveling sales people). A physical location will also include other locations where materials or equipment is stored for support of the primary location. (WCxKit)
 
 
Excluded Injuries and Illnesses:
All injuries or illnesses must be listed on Form 300 unless it is determined that they are not work related. Examples of injuries or illnesses that could be excluded from the Form 300 would include:
 
1.      injuries that occur when the employee is not on the job
2.      injuries that occur while the employee is traveling to or from work
3.      illnesses that manifest themselves at work but are not related to the job, for example the employee develops a fever due to the flu
4.      injuries that occur while the employee is involved in a personal activity, for example the employee trips and falls in the cafeteria while on his lunch break
5.      injuries from an altercation with another employee over a non-work related subject
 
 
Types of Recorded Injuries and Illnesses:
The types of injuries and illnesses that must be listed on the Form 300, per OSHA, are:
1.      death
2.      loss of consciousness
3.      days away from work
4.      restricted work activity or job transfer (due to injury or illness)
5.      medical treatment beyond first aid
6.      work-related cancer
7.      chronic irreversible disease
8.      a fractured bone
9.      a punctured eardrum
10. any needle-stick or other sharp object puncture that is contaminated with another persons blood or potentially infectious material
11. any case requiring the employee to be medically removed under the requirements of an OSHA health standard
12. any tuberculosis infection
13. any employee hearing test that demonstrates the employee has loss hearing in one or both ears
 
 
Employee Privacy:
Even though you must record all work-related injuries and illnesses, there are some situations where you record the injury or illness, but do not record the employees name. According to OSHA Guidelines, situations where the injured employee or ill employees name would not be recorded include:
 
1.      injuries or illness to an intimate body part or to the reproductive system
2.      injury or illness resulting from a sexual assault
3.      a mental illness
4.      a case of HIV infection, hepatitis or tuberculosis
5.      any needle-stick or other sharp object puncture that is contaminated with another persons blood or potentially infectious material
6.      other illnesses, if the employee independently and voluntarily request their name not be entered on the Form 300
7.      As Form 300 records information in regards to the employees health, you are required to keep the information protected as you would any other employee health related information.
 
 
Description of Injury or Illness:
The OSHA log requires you to describe the injury or illness, to identify the body parts affected and to list the object or substance that injured the person or made the person ill. An example of the listing would be:  fractured left leg, caught between forklift and wall.
 
 
Restricted Work:
When the medical provider who treats the injured employee recommends keeping the injured employee off work while they heal, or allows the injured employee to return to work on a modified duty basis, the restricted work must be included on the Form 300. Also, if the employee can return to work but with limited hours, he/she also should be listed on the OSHA log.
 
 
Counting the Days:
When an employee is off work due to an on-the-job injury or due to an occupational illness, the number of calendar days missed from work is recorded on Form 300.   The counting starts with the day after the injury as day one, and continues to the employee returns to work full time or you reach 180 days. If the employee is off work for a period of time and then returns to work on restricted duty, you are required to do two separate entries on the OSHA log. You must count the total number of days off work, then start counting again to record the number of days on restricted
 
 
Record Keeping:
The Form 300 is to be kept for 5 years, not counting the year during which the OSHA log is filled in. You are not required to send the Form 300 to OSHA unless they ask you to do so, then you must. A summary page, known as OSHA 300A listing the total number of reported work-related injuries and illnesses, the total number of days missed from work and the total number of days of restricted work, and the illnesses and injury types, must be completed. The Form 300A is posted at each location where the OSHA log was kept, from February 1 to April 30 of the following calendar year. (WCxKit)
 
 

Exempt Industries:
Some industries are exempt from OSHA recordkeeping requirements based on SIC codes; it is an exhaustive list which can be found at: http://www.osha.gov/recordkeeping/ppt1/RK1exempttable.html 

 

Additional Information:
Additional information on the Form 300 can be reviewed in OSHA Regulations 29 CFR 1904.7,  29 CFR 1904.7(b)(5), and   29 CFR 1904.29.

 

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website 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. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com or 860-553-6604.
 
 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Tips and Hints About Prior Injuries and Prior Medical Records Relevancy in Canada Workers Compensation

In Ontario, Canada  the Workplace Safety and Insurance Board  (WSIB) considers prior injuries and prior medical records for several reasons, according to Ontario, Canada workers’ compensation attorney David Brady of Hicks Morley.  If the current injury is a recurrence of a prior work-related injury, the WSIB claim number remains the same.  If the current work-related injury is new, it will be given a new WSIB claims number. Use medical records to establish date of injury. This is significant  for Schedule 1 employers.  Schedule 1 employers comprise most of the private sector employers and some public sector employers who have opted for coverage under Schedule 1. Except for very small  employers and construction employers, Schedule 1 employers are experience rated under a New Experimental Experience Rating program (NEER). NEER is based on actual and expected claims costs for each claim within specified claims costs maximums. In its very simplest  form, employers are classified by business activity and pay annual premiums based on the risk assessment associated with their industry rate group.  Employers in the NEER program receive annual surcharges and rebates depending upon how their experience relates to the experience of their rate group.  The experience rating model works (workersxzcompxzkit) on a moving three-year claims experience wheel.  If there is a recurrence and the original claim is outside of the moving three-year period, it will not count in the annual surcharge/rebate calculation. If the current  compensation claim is new and not connected to a prior claim, it counts in the annual surcharge/rebate calculation. Bottom line,  accident claim dates matter with respect to an employer’s annual experience rating results. Prior injuries and prior medical information are, therefore, important in establishing whether accidents and claims costs are new or connected with earlier workplace events. Of course, all relevant medical information must be brought forth (voluntarily or by subpoena or by order of the WSIB/WSI Appeals Tribunal) to establish entitlement under the legislation. The worker must show, on a balance of probabilities, that the workplace was a significant contributing factor of the worker’s medical condition(s). Author: Attorney Brady can be reached at 416-864-7310 or david-brady@hicksmorley.com www.hicksmorley.com of Toronto, Canada. Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

What Should a Doctor Do When Asked to Provide a Disability Report

“Doctor, I need a report that says I can’t work”… The above is a request increasingly  made due to the explosive growth of disability programs – federal, state and private. But does this burden fall on the treating physician  – or someone else? Nearly all disability programs  measure entitlement by vocational, not medical, standards, except where injury or illness is so devastating that vocational considerations are not necessary. So who is most qualified to answer the question of ability to work? In the view of nearly all Social Security administrative law judges it is the testimony of the last employer that counts the most. The last employer  is in a position to describe accurately the physical requirements for a job, what alternate employment might be available and – most importantly – what restrictions were obvious if the employee attempted trial work. Sadly, few attorneys make the effort to secure cooperation from this most valuable source of information. Those who do are praised by the judges for the quality of the presentation of a claim. So how should a medical group  deal with the requests for a report? A brusque refusal is not advised. Instead, the medical group should advise the patient that records and reports, properly requested, will be forwarded but that the employer has a most vital role to play. If there is an attorney, this can be cleared up by an office manager with a single phone call. If not, tell the patient to have the employer contact the agency to determine how they can assist. Will the employer cooperate?  Almost always yes, and with compassion. Employers and co-workers are a little appreciated support group for a worker with extended disability. Too often they believe they have nothing to contribute except sympathy – a failure in claim preparation, nothing else. A medical group can,  therefore, respond to the request for a disability report with something far more valuable than a note that in the end carries little weight – it can provide the correct answer. Attorney Theodore Ronca  is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. WC Cost Calculator www.ReduceYourWorkersComp.com/calculator.php REAL COST of work comp. WC 101 www.ReduceYourWorkersComp.com/workers_comp.php for the basics about workers comp. Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Three Types of Medical Records Often Missing in Workers Comp Claim Files

Using an MD proactively can improve IME results and save money. Spending more can save money! A well-trained MD can improve the outcome of an IME and reduce overall costs by making sure all pertinent records are in the file. Dr. Dubin identifies 3 types of medical reports that are often missing in workers’ comp claim files.

1- Emergency Room Records were not included in file– In one company we reviewed, 4 out of 30 claims at one claim office the emergency room records were not included in the file. The adjuster did not even know they were missing and had not requested them. These are critical because the injured employee will usually give the most accurate account of how the injury occurred during the ER visit.

2- Pre-injury records may be relevant to determine if there is an underlying degenerative process still progressing. For example, one worker had been having shoulder problem for 18 years. He injured his shoulder at work but then recovered. Six months later he needed shoulder surgery but the IME physician was not asked whether the surgery would have been needed regardless of the workplace incident. The workers’ comp insurer paid for the whole claim even though the answer to the unasked question was “yes.” An MD review of the claim would have uncovered the claim was more properly paid by the group health provider. An opportunity for saving was lost.
In another claim, where an overnight driver had driven over a minor bump in the road and then complained of extreme pain the MD looked for and found found another possible source of pain — Paget’s disease of the bone, as evident on the MRI; the pre-injury records were then obtained and the company successfully challenged the claim saving over $50,000.
In another claim an employee was injured in a minor automobile accidents and weeks later complained of back and neck pain, the medical advisor found indications in existing x-rays of possible Hill-Sachs deformity which suggests prior shoulder problems most likely from past dislocations of the shoulders. Pre-injury records were necessary to challenge the claim saving over $100,000 in medical and lost-wage costs.

3- Waiting on Reports– If reports from specialists are not yet in the file, it may be better to schedule the IME AFTER the report is received, especially in states that allow only one IME every six months. Also, sometimes an IME is done before the MRI results are in. Because MRI results can suggestcausation or degree of injury, such as in the above case of Paget’s disease, the IME should be done after those test results are in the file.

For more cost-saving tips go to WC Cost Reduction Tips.
Show the REAL cost of workers’ comp with the Real Cost Calculator.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It includes 60+ documents, forms, checklists in a step-by-step format

Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any aspect of a cost containment program.

©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

What Is Best Way To Deal with Pre-existing Injuries in an Aging Workforce

Our Medical Director, David Dubin MD, also known as "Dr. Dave," says that getting medical records prior to the workplace injury is important to establish a baseline.

Once there has been an injury, looking to see if there has been a pain free interval which can suggest that the current pain is the progression of underlying disease and not due to the specific workplace event. Dr. Dave says this is particularly true with spinal stenosis. Getting functional capacity tests is also helpful.

When Dr. Dave reviews medical documentation he looks for lack of correlation between what the x-ray looks like and extent of disease, particularly with back and knee injuries. Misunderstandings about the significance of bulging discs, etc. is very important.

If your medical director IS doing these things you are lucky 🙂 . If not, you'll need to teach them. Yikes, teaching a doctor, that's gonna be tough 😉 . Remind me to discuss what to do if you have a medical director who is NOT doing these things. We'll get Dr. Dave on the blog to help us with that.

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de