Impacts of putting off medical care after injury

Legal nurse consultants frequently find that a claimant has delayed treatment. Sometimes the delay may be only days, but many times the delay extends into weeks or months after the injury.

The problem

Delayed treatment makes it difficult to establish what injuries, if any, are causally related to the incident. With any gap in treatment, we cannot reliably know a claimant’s clinical presentation immediately after an injury, which is key to assessing the legitimacy of an insurance claim.

The medical perspective

Without a complete understanding of the claimant immediately after the injury, there is no way to unequivocally relate subjective complaints reported well after an injury. What’s more, when analyzing the claim, the rule of thumb is this: Compare subjective complaints to objective findings. Delays make this more difficult.

If the claimant is not evaluated within a reasonable timeframe after the incident, any bruising, contusions or lacerations, which may have occurred at the time of injury, would likely have resolved, leaving it impossible to assess for signs of direct trauma.

The bottom line

As legal nurse consultants, we are asked to review medical records and render an opinion if the alleged injuries are consistent with the mechanism of injury.  So another critical question is this: What the delay may indicate about the injury and treatment.

An argument could be made that if someone is really injured they would NOT delay seeking treatment for an extended period of time. Any delay also allows for ADDITIONAL injuries, which could potentially draw into question the legitimacy of the original injury itself.

While we may not be able to directly relate subjective complaints reported weeks or months after the injury, what we can do is provide the claims handler with information about why the delay or absence of medical care makes it very difficult to relate the complaints to the incident.

Debra West, RN, BSN,CCM, LNC is a legal nurse consultant with MKC Medical Management.  Contact Debra at debra@mkcmedicalmanagement.com or 865-551-6800.