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.
The critical importance of reading progress notes
This nurse review related to a trip-and-fall injury. A simple trip and fall developed into Avascular necrosis (AVN). The claimant reported tripping and falling onto her left shoulder, sustaining a left comminuted, non-displaced fracture of the humeral...
When age becomes a key factor in a claim
While the records in this case lined up with the complaints, the claim was deemed excessive because of the claimant's age and her pre-existing history. First, here's what happened. The claimant -- an 81-year-old female -- was injured when a truck struck her...
Case study: When delay and overtreatment figure into an MVA claim
The nurse reviewer in this case spotted several inconsistencies in this tractor-trailer related personal injury. Upon analysis, these raised red flags about the soundness of the claim. The matter involved a 55-year-old male who was the restrained driver of a tractor...
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...
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