Thought Leaders
Our professionals speak and publish frequently on the complex medical issues facing business owners and executives, lawyers, insurance claims adjusters and others dealing with claims and medical expenses. Our blog is a way for us to contribute to our field and to demonstrate the depth of our experience.
When omitted records raise red flags in a personal injury claim
In this personal injury case, omitted pre-Date of Loss records specifically imaging reports caused the nurse reviewer to wonder if the claimant's injuries were the same as before the accident or had progressed. The same is true of omitted post-DOL pain...
Root Cause Analysis from a Legal Nurse Consultant’s claims management perspective
A colleague recently shared an article that caught my attention…and triggered several take-aways. Medical Malpractice Claims: Pivotal Role of Root Cause Analysis was published by the Joint Commission, a U.S.-based nonprofit that accredits more than 22,000...
A nurse review validates a client’s understanding of an MVA-related claim
The claimant in this case was a 21 year old involved in a Motor Vehicle Accident. According to the medical records, the claimant suffered minor Date of Loss injuries followed by reports of several versions of the Mechanism of Injury and of evolving stated injuries,...
An MVA case where the data and the claim don’t align
This motor vehicle accident case illustrates the importance of complete medical and occupational records. It also shows how a thorough and detailed review and analysis was of value to the client. The event and injury The claimant was the restrained front seat...
Case Study: Showing how Mechanism of Injury and a claimant’s history must align with the alleged acute pathologies in a personal injury
This MKC nurse review highlights the importance of the MOI with the injuries in a trip and fall claim. It also shows the importance of establishing a claimant's history and its relevance to the claim. The review involved the case of a 73-year-old female with an...
Case Study: When subjective claims and objective findings don’t match
In this case, a low-velocity Motor Vehicle Accident resulted in injury claims that were not clinically consistent with objective findings. The data points suggested other motives for treatment or possible drug seeking behavior. These data points were: The...
When delayed treatment and professional activities come knocking
This nurse review of the medical records revealed data points which raised concerns with this Motor Vehicle Accident-related claim. Despite his injury claim, the claimant delayed treatment -- raising the possibility of an intervening injury -- and the initial...
Lung Disease, COVID-19, and Claims
NOTE: This article originally appeared on theskylinegroup.org. Long before the novel coronavirus became front-page news, we knew that respiratory diseases were serious business. In fact, respiratory diseases are the leading causes of death and disability...
A refresher on the basics of ED records
It's always good to be reminded of the importance that emergency department (ED) records play in the management of a medical claim. As we've written before: An emergency room is the first place many go for medical care. And those ED records provide a critical,...
Spotting red flags in a motor vehicle injury claim
In this MVA-related case study, MKC red-flagged some big inconsistencies that helped to mitigate a $2.85 million demand. It underscores the importance of Mechanism of Injury (MOI) and of sounding the alarm when key records are missing! See if you can...
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