Need to really understand a claim?
Then understand the Mechanism of Injury
Understanding and accurately interpreting the Mechanism of Injury are essential to determining if an injury is directly related to an event or accident.
Making sense of the facts
Insurance claims typically assert that someone with an injury fell in a certain direction and extended their arms to break the fall. In the case of motor vehicle accidents, claims usually detail the placement of an individual in the vehicle, whether they were restrained, the point of impact, speed, and so on.
An individual in a car with a rear-end collision, for example, will potentially have much different injuries than someone who is hit from the side at a high rate of speed.
These pieces of factual context are used to understand injuries and the legitimate basis for claims.
Related or unrelated?
Claims often include treatment for injuries related to an accident which are entwined with non-injury diseases or conditions. In addition, medical providers often identify and treat solely on the injury description provided by the patient – whether related to an injury or not.
In order to untangle what is not directly related to the injury, there has to be a clear understanding of the injury details and Mechanism of Injury. Appropriately trained and experienced medical providers can separate related and unrelated parts of a claim and reduce the overall claim exposure. That’s because they understand Mechanism of Injury and its physical effects.
The bottom line
Injuries can be caused by a single event or can have multiple factors, and the presence of risk factors can make the individual more prone to injury. Once the Mechanism of Injury has been clearly identified, attention should focus on potential causes (e.g., internal/external risk factors, pre-existing conditions).
The ultimate goal is to ensure appropriate treatment only for injuries directly related to an event. This can help produce cost savings and reduce claims exposure.
Debra West is a Registered Nurse and Legal Nurse Consultant with MKC Medical Management, Inc. Contact Debra at firstname.lastname@example.org or at 865-551-6800.