Monday, December 27, 2010

Must Discover Pre-Existing Conditions

People vs. Brown

In reading the People vs. Brown case (link to case summary is above) there are several things that we can draw from this particular study. The first indicator that should stand out in is the lag in time between the accident and the claim. The second indicator that we should take a look at is the alleged injury to the left knee which was never disclosed in the original claim.

One of the "Red Flags" of possible fraudulent workers comp claims is in the timeliness of the actual claim. That should have given clue that there should be further investigation to the claim. In most instances in a genuine workers comp claim, incident date and claim date are typically very close together. The more time that passes the more adjusters should take caution. The longer wait may indicate the thought process of the claimant wondering "what can I get out of this" and how do I proceed.

The second "Red Flag" that should draw our attention is the injury to the left knee which was never included in the original claim. When details of which body parts were injured and how they were injured change or simply appear out of no where, adjusters must research the possibility of prior claims and an injury completely unrelated to the claim. In this situation a Medical Records Canvas could have been done to investigate the background of the claimant and all prior treatment dates for that claimant.

A Medical Records Canvas allows the adjuster to see all the treatment dates for your claimant for up to 15 hospitals or a 30 mile radius. The canvas can be completed for hospitals or can also be completed for pharmacies, clinics, physical therapy or chiropractic records. This time saving service gives you specific locations and dates to focus in on and can typically be completed within 48 hours  of  the assignment date.

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