Choosing the Right Path: A Case Study

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by Jason Turk

 

     Imagine you are driving and come to a fork in the road. The path to your right is your GPS guided route, familiar and clearly marked. The route to your left is unfamiliar, but given the flow of traffic it’s worth considering. There is limited time to choose and you must make this decision based on your experience, skill, and intuition.

     Similarly, there are two ways to navigate questionable Workers’ Compensation claims: medically and legally. Both paths should be explored and both have the possibility of road bumps. One factor that may impede your progress is if an injury is unwitnessed. During a recent claim review with a California Third Party Administrator, an INTERTEL client found themselves at such cross-roads.

     In October, 2018, a long-term employee timely reported an unwitnessed slip and fall, claiming a back injury. Initial diagnostics confirmed an injury at the S1 vertebrae. Although MRI findings were positive for an injury, the treating physician was skeptical of the mechanism of injury given the claimant’s long-term struggle with obesity. At the request of the employer INTERTEL performed a Medical Canvass that uncovered treatment prior to the date of loss. Upon reviewing prior treatment records, the treating physician concluded the claimant felt pain, but was not injured, during the reported fall. Her condition was ruled symptomatic and linked to her pre-existing condition.

     Reserves were initially set at over $250,000 in anticipation of Temporary Disability Benefits, surgery, a mandatory weight loss program, physical therapy, and Permanent Disability Benefits. In December 2018 the claim was dismissed, with less than $14,000 in claims cost. The INTERTEL Medical Canvassing Program assisted this client with navigating through the twists and turns of a complicated workers’ compensation claim. Because of INTERTEL, our client had a soft savings of over $225,000.

When it comes to choosing your claims path, trust INTERTEL to lead the way.

 

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