It’s a fall. But what kind?

Posted by on Sep 12, 2017 in Blog

  A guide to 8 of the most common kinds of falls and the 14 questions you should ask   Editor’s note: This is the third and final post in a series on evaluating fall-related claims and cases. The first installment covered why it’s critical to understanding the mechanism of injury and the resulting bodily injury that happen during a fall. The second explored the reasons why we fall. Not all falls are created equal. The injury from a slip, for instance, could be completely different from a stumble or a trip. Knowing how the fall initially occurred will give you a foundation for what body part struck the ground or another object first. According to literature, there are multiple kinds of falls. Rotational, same level, elevated level, tumble, free fall, trip, stumble and slip are among them. Many overlap in dynamics and biomechanic identifiers. Here are some of the more common types of falls we have seen over the past 20 years in our practice and their associated hallmarks. Elevated This is a fall from heights such as a roof, scaffolding, platforms or ladders. These falls usually results in severe injuries such as fractures and head trauma. Many are fatal. Elevated falls usually lead to a very costly case involving medical, rehabilitation and home health costs.  Permanent physical damage often results. Early medical involvement such as case management and early evaluation, including an accurate claims reserve, are recommended. Same level falls These are falls that occur on a surface that is fairly level, including walkways, floors, sidewalks and stairs. The fall occurs when, for whatever reason, there’s a disruption in the step, gait or center of gravity. However, the mechanism of the “kinds” of same level falls varies. Each has a fairly predictable mechanism of injury signature. Understanding each and their associated hallmarks is important to analyzing the injury, associated claim and bodily impact points. As with many of these falls, there is a reflexive response initiated in the brain that extends an arm in an effort to “break” the fall. Additionally, the body’s center of gravity is changed in the fall and can follow the momentum of the gait. Here are six different kinds of falls that typically happen at ground level: Trip A trip typically occurs when a person fails to navigate over an obstacle that’s sitting low to the ground. The trip jerks a person’s center of gravity away from its base of support. The victim typically falls forward on one or both knees and their belly or face and sustains injuries to their head, neck, hips, thigh, knees, ankle and foot, along with their hands, wrists, shoulders or elbows if they attempted to stop...

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It’s not just physical

Posted by on Jul 18, 2017 in Blog

A primer on why we fall – and why everybody is at risk Editor’s note: Last week, we covered the importance of fully understanding the mechanism of injury and the resulting bodily injury that happens during a fall. Today, we cover why people fall and how it’s not just because of missteps or slippery surfaces.  This is the second installment of three installments. It’s easy to understand why construction workers or retail workers, who are working in unsafe environments or are constantly on their feet, are more likely to fall than other workers. Seniors also are at risk because they may have lower body weakness; vision problems; foot pain; or use medicines that could make them less sure-footed. But science – and experience – shows us that just about anybody can be prone to a fall for all kinds of reasons – wet flooring, uneven sidewalks or improper footwear. For most of us, walking is something we do without much thought. In reality, the simple step of putting one foot in front of the other requires a complex partnership between our muscles and our central nervous system. Regarding slips and falls, a 2013 report in the Encyclopedia of Forensic Sciences shows that there are two important phases to consider: Soon after the heel meets the ground and when the front part of the shoe or foot is touching the ground. And there are plenty of factors that impact our stability. The farther apart our feet are as we stand, for instance, the more stability we have. And our center of gravity as compared to that base of support or, foot spread, also is critical. An article on summed it up this way: “High stability (low mobility) is characterized by a large base of support, a low center of gravity, a centralized center of gravity projection within the base of support, a large body mass, and high friction at the ground interface. Low stability (high mobility), in contrast, occurs with a small base of support, a high center of gravity, a center of gravity projection near the edge of the base of support, a small body mass, and low friction.” How our brains are involved Our brains, of course, also play a role in the way we walk and assess slippery or tricky walking surfaces. When we’re walking, we’ll look to see if the path ahead of us is safe. If it is, we’ll continue that evaluation as we walk forward – shifting our weight or changing our gait if the path turns out to be slippery or uneven. “It is clear that ‘expectancy’ is required to walk – that is, during walking, we expect the ground to be...

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Slips, Falls, Tumbles

Posted by on Jul 11, 2017 in Blog

Why there is always more to the story when assessing fall-related claims, cases Editor’s note: This is the first in the three-part series on evaluating fall-related claims and cases. A misstep. A wobble. And, then, bam. In a millisecond, a trip, slip or fall can lead to life-changing injuries, along with bulging medical files, an insurance claim and, often, a court case. Indeed, the business behind fall-related insurance claims and court cases is big. At home, at businesses and at work, falls cause thousands of injuries and hundreds of deaths each year, leading to billions of dollars in workers’ compensation costs and medical claims. Here at MKC Medical Management, attorneys and insurance adjustors regularly hire us to review and advise on cases that involve a fall. In fact, our practice has reviewed hundreds of claims involving various kinds of falls during the past 20-plus years. We aren’t biomechanical engineers. But, as legal nurse consultants and clinicians, we have a fundamental understanding of fall mechanics. Claim strategies are often based on understanding the mechanism of injury and the resulting bodily injury. Without that expertise, you risk missing out on critical details of a case and have less control over its final outcome. Always more to the story Environmental hazards – icy sidewalks, uneven curbs, bumpy pathways – typically drive personal injury and property casualty claims. But, for insurance adjusters and attorneys, when it comes to determining what caused a fall injury, there’s always more to the story than the weather report and emergency department records. The challenge when evaluating most falls is determining the validity of the allegation: Was it really the rain-soaked tiles that caused the fall or could there be another reason – the claimant’s high heels or a chronic illness that makes the person unsteady on their feet. Not all falls are the same. In fact, each type of fall – from a trip to a slip to a crumple – has its own distinct thumbprint. To completely evaluate a fall claim, a thorough understanding of the biomechanics of the fall, a complete story about what happened and a full assessment of what’s inside those complex medical files is vital. Who’s at risk? Slips, trips and falls make up 15 percent of all accidental deaths, according to the federal Occupational Safety and Health Administration. They also are a leading cause of fatalities – second only to motor vehicles. On the job, injuries from falls produce a major strain for employers. In 2014, more than 260,000 private industry and state and local government workers missed one or more days of work because of a fall, according to the Bureau of Labor Statistics. That year, almost 800 workers died....

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Is a nurse case manager the plaintiff’s friend?

Posted by on Jun 27, 2017 in Blog

Why the answer may surprise you   Your client recently suffered greatly from an injury and is seeking what he feels represents adequate compensation so he can recover and return to the workplace – if returning to work is possible. Then you learn that the insurance company has engaged the services of a field nurse case manager to actively work the case. Immediately, you assume that they plan to severely limit your client’s compensation – the compensation they are owed – or, even, may begin to push for a return to work. In your mind, the list of drawbacks can go on and on. Bottom line, you may think that the hiring of a nurse case manager by an employer or payor is not a good sign and poses a direct threat to your case. Right? Well, not exactly. Don’t fall prey to flawed assumption Yes, plaintiff attorneys commonly assume that the influence of an authoritative nurse case manager can only spell trouble for the plaintiff’s case. But don’t fall prey to this flawed assumption. An experienced nurse case manager with high integrity can be just as much of an asset, if not more, for the plaintiff as she is for the defendant. Examine this assumption by considering the true objective of the nurse case manager: They are tasked with guiding a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes, according to the Case Management Society of America. The professional nurse case manager should focus on the best treatments available, helping to move and navigate the injured worker through various diagnostics; physicians and providers; treatments; rehab; and, eventually, a return to work, if and when appropriate. Insisting on best practices In addition, she uses her knowledge, experience and observation to ensure that the physician and other providers follow these best practices through the entire case. She can do this for the plaintiff’s case just as well as she can for the defendant’s. Those findings may favor the injured worker. They can enlarge the plaintiff’s case, provide for a stronger case and support the award of more substantial proceeds. Those findings also can backfire on the insurance company or employer – more quickly than a clogged blunderbuss if they have not focused on best medical practices, attempted to do damage control or are trying to cut corners just for expediency. The professional nurse case manager can provide supportive and verifiable information and numbers that may indicate that your client might never be able to return to work or a normalized lifestyle. They may even find that your client also needs...

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The Forever Battle

Posted by on Jun 20, 2017 in Blog

Reducing and preventing physician medication order entry errors Physician medication orders entered for the wrong patient is a constant battle for hospitals. At MKC Medical Management, as we investigate our client’s claims and cases, we see it all of the time. Many factors can lead to medication errors. In fact, the Institute for Safe Medication Practices has identified 10 key elements with the greatest influence on medication use and notes that weaknesses in these areas can lead to medication errors. They are: patient information drug information adequate communication drug packaging, labeling and nomenclature medication storage, stock, standardization and distribution drug device acquisition, use and monitoring environmental factors staff education and competency patient education quality processes and risk management Medication administration is a complex and multistep process that involves prescribing, transcribing, dispensing and administering drugs, as well as, monitoring patient response.  An error can happen at any step, but we see many errors happening in the beginning – at the prescribing stage.   Researchers tackle issue With the introduction of electronic medical records, there have been numerous studies focused on ways to reduce and prevent order entry errors. Researchers at Montefiore Hospital in New York, for instance, wanted to find a way to detect wrong-patient orders in their electronic medical records system. They devised a tool to track errors, such as prescribing medications for the wrong patient, and to suggest ways to reduce potentially life-threatening mistakes. The study lasted from December 2010 to June 2011. It found that two different interventions could decrease the number of wrong-patient orders that were later retracted. Phase 1 of Montefiore’s research: Physician Interviews Interviews with 233 physicians over a four-month period showed that 76 percent of the original orders had been for the wrong patients. They were near misses that could have turned into actual medical errors involving orders for imaging or lab tests or medications. Their findings of the study translated to wrong-patient electronic orders being entered by one in six clinicians for one in every 37 patients admitted to the hospital, an average of 14 such orders per day. This did not include or reveal how many orders for the wrong patients went through and were carried out. Phase 2 of Montefiore’s research: Verify Patient Identifiers In the randomized controlled trial, 4,000 providers were assigned to groups, which were prompted to verify patient identifiers before entering orders, re-entering patient identifiers – or neither. The results were encouraging compared to the control group. ID verification reduced the odds of retract-and-reorder events by 16 percent; ID reentry decreased them by 41 percent. It took clinicians only half a second on average to verify a patient’s ID, versus 6.6 seconds for reentering identifiers. The latter...

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Tips, Trends and Findings

Posted by on Jun 13, 2017 in Blog

Here are studies, reports and stories that caught our eye in the last month. No “standard” claim: Isn’t one rear-end crash like every other rear-end crash? No, says an article in Property Casualty 360 that’s part of a six-part series about adjuster ethics. “Each claim is unique, the people involved are individuals, and each claim needs to be adjusted on its merits,” the article says. “When we try to do away with individualism in each loss, we either over-pay or under-pay, hence the claim is no longer ‘fair and equitable.’” Bodily injury claims: Claimants must prove both liability and damages to be entitled for compensation in bodily injury claims. But, says an article in Claims magazine, liability is often overlooked. “A good rule of thumb for all adjusters is to never underestimate the importance of liability as a critical element of the claims investigation,” the article says. “Beyond the potential accuracy improvement in indemnity payments, there is a dramatic rise in subrogation potential.” Cars could someday alert drivers to their own medical emergencies: Sudden cardiac events for drivers behind the wheel can turn into tragedies for not only the driver, but his passengers and others on the road. Toyota, along with a team of researchers at the University of Michigan, are exploring technology that could monitor a driver and predict if they are going to have a heart attack or other adverse cardiac event while driving, according to an article in Insurance Journal. The role of social media in personal injury claims: Defense attorneys are adding a new weapon in their arsenal as they fight personal injury claims: A plantiff’s social media accounts. “Many plaintiffs make things very easy for the defense, simply by posting things on social media that undermine their claims,” says an article in Forbes. “For example, a simple post about mowing the lawn could be used as evidence to refute a personal injury claim about a back injury.” Can robots review personal injury claims? The answer, at Zurich Insurance, is yes. The company is using artificial intelligence to decide personal injury claims. “We recently introduced AI claims handling … and saved 40,000 work hours, while speeding up the claim processing time to five seconds,” chairman Tom de Swaan told Reuters as reported in Claims Journal. The robots began doing the work in March to review paperwork, including medical...

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