By Debra West, RN, BSN, CCM, LNC

delaysLegal 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 post injury, there is no way to unequivocally relate subjective complaints reported well after an injury. 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.

Experience has shown that delays in treatment often correspond to a claimant’s lack access to care or to their inadequate insurance coverage. In many cases, treatment may occur months after an injury, when the claimant hires an attorney.  Merely a coincidence?  Maybe.

Experience has shown that delays in treatment often correspond to a claimant’s lack access to care or to their inadequate insurance coverage.
In many cases, treatment may occur months after an injury, when the claimant hires an attorney. Merely a coincidence? Maybe.

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.  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 the necessary information why the delay or absence of medical care make it impossible to relate the complaints with the incident.

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