Friday, April 13, 2012

The Power Of The Medical Records Canvass

Medical Records Canvass can be an invaluable tool to determine if a preexisting condition is a contributing factor to an injury. This type of service can save a claims representative hours and hours of work by laying a foundation for prior medical care. The basis for completing a MRC is to determine if an injury that occurred at work may have resulted from or contributed by a prior injury. In either case the amount of exposure your company may be liable for can be considerably less if the injury was preexisting.

In this case study we look at claimant Joe smith with a right shoulder strain that was injured while on duty. Joe was a self professed softball player that often bragged about his baseball prowess and how he took his high school baseball team to the state championships. Joe returned to work Friday and was injured while attempting to repair equipment in a warehouse, causing him to strain his right Deltoid. Mr. Smith remains out of work and can not lift, push or pull more than 10lbs with his right arm. When NSIU received the call for Mr. Smith's case the adjuster informed our Certified Investigative Consultant that she knew the subject had played softball and would like to get surveillance. After taking the information for the referral the CIC found out the subject was a baseball star in high school and that was the reason the adjuster believed the claimant may still be playing softball in some capacity. The CIC reasoned that since the claimant had been so successful in high school but did not play in any college setting there may be a reason he never made it. We suggested doing a Medical Records Canvass to see if he had previous injuries that may have prevented him from moving on in his baseball career. Sure enough Mr. Smith had injured his right shoulder in the spring before his first college season and never was able to return to baseball. This information on a preexisting condition was key in the reduction of exposure to the claim.

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