Tips, Trends and Findings

Posted by on May 16, 2017 in Blog

Here are studies, reports and stories that caught our eye in the last month. Auto technology and insurance claims: Technology and consumer expectations are among the issues driving the evolution of auto insurance as we know it, according to an article in Property Casualty 360. The article explores “seven key areas that are ripe for further discussion, research and analysis.” Storefront crashes: “Storefront crashes,” which involve a vehicle running into a commercial, public or retail building, cost insurers millions of dollars a year, according to an article in Claims magazine. In fact, in 2015 and 2016, the Storefront Safety Council is aware of more than $100 million in claims paid. “The trend is increasing as more cases go to trial and plaintiffs find it easier to show that a location was poorly protected against a foreseeable and preventable risk,” says the article, which also details new safety standards and trends to watch. Top liability loses: Allianz Global Corporate & Specialty’s Global Claims Review 2017 recently ranked the top modern corporate liability exposures. The report finds that defective product or work; collisions and crashes; and human error were the leading causes of liability losses. Drowsy driving: At least 21 percent of fatal crashes involve exhausted drivers, according to an article in Claims Journal. But activities to keep drivers alert, including radio adjustments and opening a window, come with their own risks. The article explores the issues, signs of drowsy drivers and ways to ensure drivers get enough sleep before they hit the road. More data needed: According to a report from the National Safety Council, 2016 may have been the deadliest year on the nation’s roads since 2007. Last year, 40,000 people may have died because of a motor vehicle crash. Another 4.6 million were seriously injured. But, the council’s report says that “little is known about key driver behavior factors in these crashes because critical data is under-reported.” The report makes recommendations for law enforcement and those in the traffic safety...

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Case Study: Lead poisoning

Posted by on May 2, 2017 in Blog

Why what’s missing is sometimes the most important detail There is no safe blood lead level in children, according to the Centers for Disease Control and Prevention. But, more than 500,000 U.S. children have elevated levels, which can cause lifelong developmental delays. One of our clients, an insurance company, pulled in MKC Medical Management to review the alleged lead poisoning case of a toddler. The child was healthy as an infant, but he developed significant speech and other developmental delays. Doctors eventually diagnosed the child with pervasive developmental disorder (PDD), which is on the autism spectrum. What we found, according to the medical records, was that the child had lived in a building with toxic levels of lead. Tests also revealed that he had elevated blood lead levels. But, those findings don’t necessarily mean that lead poisoning was behind the child’s diagnosis and delays. In any case under review, correlation doesn’t always mean causation. Here are the facts of the case: Overview: The claimant is a three-year-old child who, the plaintiff attorney alleges, has developmental and behavioral issues because of lead exposure in the home. MKC’s legal nurse consultants worked on the defense team for the insurance carrier.    What the records say about the child’s lead levels At one year of age, the child’s blood level was 5 mcg/dL, which is considered elevated. Five months later, it was up to 5.3 mcg/dL. Six months later, it was up to 6.9 mcg/dL. The blood lead level was later reported to have spiked to 16 mcg/dL before dropping to 11 mcg/dL, but no lab reports for these final two tests were submitted for review. What the records say about the child’s home When the child was age two, city officials sent a letter to the property owners of the building the child was living in to notify them that there were “toxic levels of lead in or on the dwelling.” A lead abatement plan was required. It’s unknown how long the child had lived in the home and whether he had lived anywhere else. After the abatement order was issued, the family was relocated. Red flags Missing lab reports were just one of this case’s red flags. Here are some other warning signs: The child lived with five siblings, ages 2 to 12, but no test results were submitted to indicate that any of the other children had elevated levels of lead in their blood. According to an assessment with the family, there is a family history of genetic issues, sickle cell trait and seizure disorders, but the relationship to the individuals with these medical issues and more specific diagnoses were not identified. If the child has a genetic history...

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More than medical: Tips for reviewing lead poisoning cases

Posted by on Apr 25, 2017 in Blog

Lead poisoning, especially in children, has made headlines in recent years, for good reason. The condition, found in more than 500,000 U.S. children, can lead to lifelong delays, including damage to the brain and nervous system; slowed growth and development; learning and behavior problems; and hearing and speech issues. The most recent blast of headlines began with the crisis in Flint, Mich. There, after the city started drawing drinking water from the Flint River in 2014, the number of children under six years with high levels of lead in their blood almost doubled. Those rates returned to normal levels after Flint went back to its original drinking water source – Detroit’s water system. Several officials face charges in the case. But, those headlines have only continued as further research has uncovered high levels of lead poisoning among children across the country. One examination by Reuters, the news agency, discovered nearly 3,000 U.S. communities with high rates of lead poisoning among their youngest residents. More claims, cases This renewed concern means some of our clients are seeing more claims related to lead poisoning, a condition the Centers for Disease Control and Prevention calls the “most preventable environmental disease among young children.” But, to truly understand the medical records and history in those case files and get to the bottom of the cause, you’ll need to explore more than just the patient’s health information. Everything from whether the child ever lived outside the country to what products their family uses to the child’s own genetic history are critical for a fully informed review of a lead poisoning case or claim. Aware for decades The public and officials have been aware of the dangers of lead for decades. In the 1950s, the first cities started passing laws about lead-based paint. The federal government didn’t take action until the 1970s. In 1978, legislators banned the residential use of lead-based paint. When coupled with the phase down of the use of lead in gasoline, researchers documented a big drop in the average blood lead levels in the United States. These days, the most common sources of lead aren’t from house paint or gasoline, but regular exposure to things such as toys, nutritional supplements, water in lead pipes, residue from a parent’s occupation and dishware, among other items. According to the American Academy of Pediatrics, the annual cost of childhood lead exposure in the United States is $50 billion. Lead toxicity is blamed for the loss of 23 million IQ points among children and is attributed to 20 percent of cases of ADHD. Today’s goal: Prevention Today, the focus is on stopping lead exposure before it happens. According to the CDC, there is no safe...

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Separating the subjective from the objective

Posted by on Apr 18, 2017 in Blog

When Legal Nurse Consultants analyze medical records, we had better be able to compare and contrast subjective and objective documentation. In other words, we earn our keep by determining what constitutes a subjective complaint versus an objective finding. Sounds simple right? Not so fast! While these terms are used all through medical documentation, they can be confusing. Here are just a few reasons why: Non-medical people often mix the terms Medical records themselves can be confusing Attorneys and claims representatives often don’t understand the condition or clinical picture from a medical perspective Information that falls under each of the objective or subjective categories are often misunderstood, misquoted or confused. To make matters even worse, there are medical terms that actually can fall under BOTH categories. A case in point Here is an actual physical exam taken from one of our company’s case files: Physical exam: Abrasion to left knee, right 5th finger, thumb and chin. Lips also noted to be swollen. Elevated BP. Swelling noted to right hand, limited range of motion, decreased strength, tenderness to touch. Glasgow coma score 15/15. Neurovascular intact. So, is the physical exam findings objective or subjective? First, let’s review the definitions of subjective and objective. Subjective Definition: Information that is reported by the patient, BUT can’t be verified or perceived by the examiner. The examiner should document SUBJECTIVE COMPLAINTS. The term subjective findings (or subjective symptoms) is wrong. Examples: “Feeling hot,” “pain,” “numbness,” “tingling” or “nausea.” Objective Definition: Measurable abnormality or finding that is perceived by the examiner. The examiner would document OBJECTIVE FINDINGS. Examples:  Lab or diagnostic testing; fracture visible on xray; bruising; swelling;redness. So let’s take another look at that physical exam. Here’s a map, pulling out the objective and subjective elements: Abrasion (objective) to left knee, right 5th finger, thumb and chin. Lips also noted to be swollen (objective) and painful (subjective). Elevated BP (objective). Swelling (objective) noted to right hand, limited range of movement (likely both), decreased strength (likely both), tenderness to touch (subjective). Glasgow coma score 15/15 (objective). Neurovascular intact (objective). Depending on what side of the case they’re on, attorneys and adjusters typically focus on what seems to help their case. But a good evaluation depends on a clear understanding and accurate interpretation of the objective AND subjective data. The entire clinical picture – along with associated diagnostics, radiological studies and lab tests all – should be considered. And this is where it gets tricky. You have to really understand your clinical information – all of it. It is at this point that legal nurse consultants often get called to help out on a file. While a medical record may have all kinds of subjective complaints, the...

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Gym Revelations

Posted by on Apr 11, 2017 in Blog

The importance of isolating muscle groups – and case records For years, I’ve been going to the gym. I’ve run through the same workout week in and week out. I thought I was doing a great job, honing in on specific muscle groups and staying fit. So, when a personal trainer suggested I do those triceps exercises that I’ve always done with three-pound weights, not 10-pound ones, I was a little skeptical. Why? I’ll never work those muscles with just three pounds of weight, I thought. And then I did it. After the third set of 20 reps, my triceps were screaming. It turns out, I’d been doing it wrong all of the time. And, let’s just say, I’ve been taking my personal trainer’s advice ever since that day. He knows the equipment. He’s read up on the latest research. And he knows the importance of isolating those muscle groups for the most efficient and effective workout. What does this have to do with legal nurse consulting? A lot. We know the equipment. Our LNCs bring decades of experience as registered nurses. We know our way around complex medical records, including the digital kind, and complicated diagnoses. We’re always on the lookout for red flags when evaluating, for instance, a motor vehicle accident injury. We know ways to avoid getting tripped up by the pages and pages of medical records that come with just about every case. And, whether it’s lead poisoning or workplace back injury, we know the tough questions to ask – and what records are critical to figuring out exactly what happened. We know the latest research. Opioids should no longer be the go-to pain killer for certain injuries. ICUs may be overused. Let’s talk the biomechanics of minor automobile accidents. As a lawyer or insurance adjuster, you are well versed in the constantly evolving rules and regulations of your industry. And we know medicine, an always developing field that brings about new revelations just about every day. We know the importance of isolating the details. The devil, as they say, is always in the details. I’m getting a better workout because my personal trainer is teaching me how to isolate certain muscle groups. At work, we’re helping our clients “isolate” the details in every case. To the layperson, they might seem like minutiae – tiny technicalities in a medical record that seem to have little to do with the case overall. But, as experts in the field, we know that every little detail counts. In a lead poisoning case, for instance, what were the parents’ occupations? In a slip and fall, when exactly did the patient seek treatment? If you can’t master the details –...

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