Case History 1

The Claims Management Reality

 CASE HISTORY # 1

CLIENT:  CONSTRUCTION COMPANY

CLAIM:    INJURED BACK

Employee files a Worker’s Compensation claim that he injured his back while moving a pipe valve on the construction site. He receives medical services from a treating doctor and the medical bills are submitted to the carrier. As part of our program, we require copies of medical bills and a doctor’s diagnosis. Upon review of the diagnosis, we discovered that the claimant had been treated for a polynoidal cyst…an infection and inflammation that was the actual cause of his back pain, not the result of a work related accident. On our recommendation, the client informed the insurance carrier and the claim was determined to be non-compensable.

BENEFIT: Client’s reserves will be lowered, thereby reducing their experience mod and the premium.