Biomechanics: A way to better understand mechanisms of injury and how the M.O.I. measures up with a claimant’s stated injury

Posted by on Mar 8, 2015 in AALNC, Best Practices, Legal Nurse Consultant, Legal Nurse Consulting, LNC, Medical Conditions/Terminology Blog Series, RN

By Danny Marshall, RN, EMT-P, CLNC What is biomechanics? It is a scientific discipline which applies principles studied in mechanics to the understanding of living organisms. So, what does this mean to the LNC? As a LNC we are challenged to determine if a claimant’s reported injury or injuries can be the result of the mechanism of injury he/she has reported. As a new LNC I have learned this is easier said than done. I am thankful for the LNC who has helped me edit the reports I have completed, she told me to study biomechanics. Studying biomechanics has helped me to better understand the relationship between the M.O.I and the claimant’s reported injuries much better. For example disk herniations are uncommon in front and side impact cars crashes that are severe enough to cause other serious spinal injuries. In laboratory testing, pure compression, torsion and flexion do not result in disk herniation. Only a combination of lateral bending, hyperflexion, and severe compression can cause a herniation. This is usually the result of heavy lifting, but rarely occurs anywhere in the spine during automobile accidents. In rear end collisions the neck is most likely to sustain injury and the thoracic and lumbar spine is less likely due to protection by the seat and restraints. Proper placement of the head rest would be an important piece of information to obtain because it can reduce the chance of whiplash injury to the neck. So a study in biomechanics and how it relates to the body when an injury occurs can be most beneficial to a LNC who is trying to see if the claimant’s reported injury or injuries are a result of the reported M.O.I. or related to another...

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Mechanism of Injury (MOI) and its Role in the World of the LNC

Posted by on Jan 8, 2015 in Blog, Legal Nurse Consultant, Legal Nurse Consulting, LNC, Medical Conditions/Terminology Blog Series

By Danny Marshall RN, EMT-P, CLNC A definition of a mechanism of injury: Describes a particular set of circumstances that caused a given injury. An example: The mechanism of an injury from a car crash will often be described in terms of the speed, angle, and direction of the crash. Emergency medical professionals often take into consideration when assessing and describing the circumstances and causes of an injury. Pretty straight forward, you would think? Not so. As a paramedic I can think of several times I would bring in a patient involved in a motor vehicle accident and describe to the receiving medical team: The type of impact The speed at which the impact occurred The amount of  intrusion into the vehicle If the patient was restrained or not. Only to have the receiving staff not appreciate the importance of the information concerning the mechanism of injury presented to them. These descriptions are of paramount importance in ensuring proper patient care. To ignore these facts could lead to a negative outcome for the patient. So what does all this mean in the world of the LNC? In one simple word, EVERYTHING. The mechanism of injury is the heart and soul for a LNC reviewing medical records for a client. As a paramedic I would always ask what type of injury should I suspect in a patient depending on the type of event that occurred. As a LNC I am asking very similar questions as I review a medical record. Does the type of injury the claimant reports match the mechanism of injury. An example: a person has a slip and fall at a local business and now states a torn rotator cuff was the result of this particular fall. I am now asking similar questions:   How far did the claimant fall What type of surface did the claimant fall on Was it a ground level fall or a fall from a significant height Are there any pre-existing medical issues that could account for the claimant’s current injury pathology The answers to these questions is not to absolve any person or business from responsibility for an injury sustained from someone on their premises or to discredit a person who has sustained an injury. But this is an honest effort to find the truth. This is why a thorough review of medical records is of paramount importance and a healthy understanding of the significance of mechanisms of injury truly is the heart and soul in the world of the...

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Being the Pupil….

Posted by on Dec 9, 2014 in Blog, Legal Nurse Consultant, Legal Nurse Consulting, LNC, Medical Conditions/Terminology Blog Series

By Laura B. Duhamel, RN BSN, CLNC My first blog was about the role of the nurse as a teacher.  The other side of that coin is the nurse as a pupil. As a nurse, my teachers include patients (and their families), colleagues, doctors, attorneys and other nurses.  While a new Legal Nurse Consultant may have years of bedside experience, learning to apply that knowledge in the legal arena has a learning curve that needs teachers and mentors.  The more seasoned LNC can also learn and gain a different perspective from a new nurse and their fresh eyes. It’s important to acknowledge that the teacher/pupil relationship is always evolving.  It also helps to keep it positive.  We teach ourselves through the research we do in the role of a LNC as we help our clients understand the medical issues in their cases. No one knows everything, and even things that are “concrete” can change. Who would have thought that the ABC’s of CPR would have changed? It is all about circulation these days.  A good pupil must be open to new ideas and new ways to achieve the same goals. This means not becoming defensive when a new idea is proposed that challenges  the “usual” way of doing things. Fresh thoughts might be game changing in a given situation. So, be open to new knowledge and listen to your fellow nurses.  They may have experiences in which you have not shared.  Learning is a never ending delight of life.  Be the object that the “point of light” shines on!!! Laura B. Duhamel, RN BSN, CLNC is a legal nurse consultant with MKC Medical Management. You may contact her at

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Six ways to avoid getting tripped up by medical records

Posted by on Nov 11, 2014 in Blog, Legal Nurse Consultant, Legal Nurse Consulting, LNC, Medical Conditions/Terminology Blog Series, Uncategorized

Continuity of care and information are critical when reviewing a medical record. Continuum of information, evaluations and treatments start with the initial injury and travel through the medical record. But what first started out as a nice straight line quickly becomes a bowl of spaghetti, with many nuanced twists and turns. It takes an expert’s eye and first-hand experience to follow these long , slippery strands. Here are six tips to help you avoid getting tangled up yourself: Look at each medical provider closely and on its own merit. Ask, does the information at the beginning of the record hold true at the end of the record? This is particularly important for Emergency Department records. (See earlier ED blogs). For example, is what was told to the ER triage nurse the same as what was told or documented by the physician? When a claimant or patient is seen by another provider, does the information about the injury/event/diagnosis remain constant and consistent or does it morph into something else? Think of a piece of paper torn in half. Can you line up the edges to recreate that one piece of paper? If information does not line up, then that should be a red flag for the attorney or adjuster that something — some crucial fact or piece of data — may be missing or even misrepresented. If you are reviewing an inpatient stay record, look closely at the change of shift documentation. Nurses report to other nurses when there is a shift change. Is the information documented by the receiving nurse the SAME as what had been noted earlier by the departing nurse? If not, that’s another red flag. When reviewing a diagnostic report, look at the reported diagnosis and ordering physician. Is this information consistent with other documentation? Sometimes you can determine that a new physician has been brought in on the case as that physician is the “ordering physician.” This is especially true for outpatient diagnostic studies. Remember: consistency and continuity are key. Look carefully at what the injured party is reporting/describing to each provider. Is it consistent or does it change or grow? The information should be fairly consistent and make sense in the context of the alleged event and throughout ongoing treatment documents. Follow the “Trauma Timeline” through the record. Look at timing, treatment and the associated responses. Ask, did something new or different appear long after the initial injury? If so, is it a secondary complication or truly a horse of a different color?? As you can see, this process can be daunting, especially for a non-medical person. That’s where LNC’s can help. We are used to following that slippery string of spaghetti. From receiving...

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Understanding What the Words Mean

Posted by on Sep 2, 2014 in Blog, Legal Nurse Consultant, LNC, Medical Conditions/Terminology Blog Series

By Debra West, RN, BSN, BSN, CCM A close, knowledgeable analysis of what is written in the medical records can provide critical information when determining whether an injury is acute. This can be a challenge to a non-medical observer, since medical terminology is highly technical and often difficult to understand. A case in point A male patient reported that a five-pound object fell off a shelf while he was shopping in a store. It struck the right side of his face and eyebrow, resulting in multiple complaints, including a laceration with profuse bleeding. The patient did not seek medical care until four days after injury. The examining doctor documented a two-inch scar on the patient’s right eyebrow. Knowledge is power A well-trained and experienced medical provider knows that a scar has to predate this patient’s injury. While a four-day-old injury would show signs of healing, it would not have healed enough to form a scar. Scar tissue does not occur until at least four to six weeks after the injury, with complete maturation of the scar taking months to years to develop. The fact the patient had an identifiable scar indicates that the facial laceration did not occur four days prior as the patient alleged. While the word “scar” may seem insignificant, it is critical in this patient’s case, as it validates the timing of the injury. It is evidence that the patient sustained an injury months to years prior to the alleged incident four days before being examined. The presence of a notable scar provided the necessary timeline which allowed the adjuster to dispute the alleged injury. Understanding medical terminology can prevent a fraudulent claim. When properly interpreted, words which might seem trivial or unclear can hold the key to determining acute verses chronic. Debra West is a registered Legal Nurse consultant with MKC Medial Management. Contact Debra at

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Po-Ta-to… Po-TAh-to… Understanding professional terminology takes, well, a professional.

Posted by on May 25, 2014 in Blog, Legal Nurse Consultant, LNC, Medical Conditions/Terminology Blog Series, Uncategorized

by Neely L. Cotten, MSN, ACNP-BC While I was watching the nightly news a few evenings back, I cringed.  I watched as the manicured anchorwoman talked in depth of “two-type diabetes.”  As a healthcare provider, her misuse of medical terminology sounded like fingernails on a chalkboard.  I wanted to shake the television and yell “It’s type-two diabetes!  Type-two.” Then I calmed down. I remembered that it’s our job as professionals job to explain and educate the public when they step into our world.  When you and I explain and educate, we serve our patients and clients and members…physically, emotionally, financially and otherwise. We are immersed in pseudo-medical vernacular. It shows up in popular culture, our business life, and our casual speech.  Professional, technical dialects require training; lawyers, business persons, and physicians are just a few of the groups who use a daily language specific to their specialty. Case in point… A study was recently conducted to assess patients’ true comprehension of informed consent.  Informed consent is the process of obtaining permission to perform a medical intervention on a patient.  The healthcare provider must review the risks, benefits, and timeline of the procedure by speaking one-on-one with the patient.  Permission can only be granted by an individual with the capacity to comprehend what’s happening. The majority of consent documents for medical diagnosis and treatment, however, are written at a reading level above that of the majority of the US population.  Despite granting their informed consent, the study showed that patients are repeating medical terms, agreeing to treatments and accepting diagnoses they do not understand. And despite this documented effort to improve patient education, patients reported feelings of stress, confusion and anxiety prior to their medical treatment. So, as a public service… Rather than merely curse the darkness, I’ve compiled a short list of common medical terms you may (or may not) think you understand along with a brief definition! Hypertension – High blood pressure Hypotension – Low blood pressure Arrythmia – Irregular heart beat Cardiovascular – Pertaining to the heart and blood vessels Myocardial Infarction – Heart attack Diuretic – A medication used to help the body dispose of excess fluid Embolism – The blockage of blood flow in the vessels caused by a blood clot; this means oxygen and other blood nutrients cannot reach the tissues supplied by those vessels. Diabetes – A predisposed state of high blood glucose (sugar) because the body cannot create enough insulin to regulate the levels Type 1 Diabetes – A genetic condition where the body does not create its own insulin, causing very high blood glucose levels Type 2 Diabetes – An acquired condition where the body becomes resistant to its own insulin...

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