Our MKC Medical Management team sees it every day. A claimant or plaintiff prevails in high-exposure litigation or in a big insurance claim because not enough attention was given to the Mechanism of Injury (MOI) in the fall, accident or other trauma associated with the injury in question.
The MOI describes the circumstances that caused a given injury. Here’s how MOI comes into play in three major types of injury-related insurance claims and litigation defense:
- Motor Vehicle Accidents
The MOI in a motor vehicle accident is often described in terms of the speed, angle and direction of the crash. However, without a detailed analysis of the accident itself — including data on the impact on any passengers and the history of the claimant’s medical records — there are too many things that will let inadequately substantiated claims get by. For example, for a person involved in a motor vehicle accident, I want to know:
- The type and location of impact?
- The speed at which the impact occurred?
- The amount of intrusion into the vehicle?
- If the patient was restrained or not?
All too often, these MOI-related data fall through the cracks and don’t get the analysis and attention they deserve. Instead, in reviewing the medical records of a plaintiff or claimant, I always ask what type of injury should I suspect given the type of event that occurred.
For example, disk herniations are typically uncommon in front and side impact car crashes that are severe enough to potentially cause other serious spinal/bodily injuries. In laboratory testing, pure compression, torsion and flexion do not result in disk herniation. Only a combination of lateral bending, hyperflexion and severe compression can cause a herniation. This is usually the result of heavy lifting, but rarely occurs anywhere in the spine during automobile and other motor vehicle accidents.
In rear-end collisions, the neck is most likely to sustain injury, and the thoracic and lumbar spine are less likely to be injured because of protection provided by the seat and restraints. Proper placement of the head rest would be an important piece of information to obtain during an accident investigation because it can reduce the chance of whiplash injury to the neck.
2. Workers Comp
In Workers Comp cases, my MKC colleagues and I ask if the type of injury the claimant reports matches the Mechanism of Injury. In a slip-and-fall-related claim involving, say, a torn rotator cuff or other shoulder injury we look for medical and historical evidence that the shoulder condition is the result of the fall in question…or, if there’s a possibility that it’s a result of an earlier, unrelated, recurring-use condition.
So, I ask questions such as:
- How far did the claimant fall? And, how did the injured worker specifically fall? For instance, directly on the shoulder or on an outstretched arm?
- On what type of surface did the claimant fall?
- Was it a ground-level fall or a fall from a significant height?
- Are there any pre-existing medical issues that could account for the claimant’s current injury pathology?
The answers to these questions are not to absolve any person or business from responsibility for an injury sustained from someone on their premises or to discredit a person who has sustained an injury. Instead, this is an honest, defensible effort to find the truth and to determine whether the claimant’s reported injury or injuries are a result of the reported M.O.I. or are related to another incident.
This is why a thorough review of medical records is of paramount importance along with a healthy understanding of the significance of Mechanisms of Injury and the biomechanics at play in an injury-related claim. Biomechanics is a scientific discipline which applies principles studied in mechanics to the understanding of living organisms.
Take a look at this post “Biomechanics: A way to better understand mechanisms of injury and how the M.O.I. measures up with a claimant’s stated injury” for a deeper understand of this perspective.
Fall-related insurance claims and court cases are a big part of what the MKC Medical Management team handles, day-after-day and year-after-year. Falls cause thousands of injuries and hundreds of deaths each year – at home, businesses and at work — leading to billions of dollars in workers’ compensation costs and bodily injury claims.
Claim strategies are often based on understanding the Mechanism of Injury and the resulting bodily injury. Without sufficient expertise, it’s easy to miss out on critical details of a case and to have less control over its final outcome. So, clients regularly turn to us to review and advise on cases that involve a fall. In fact, our practice has reviewed hundreds of claims involving various kinds of falls during the past 20-plus years, leveraging our medical training, experience and fundamental understanding of fall mechanics.
Common sense also comes into play in spotting what’s in — and not in – the record. For example, environmental hazards – such as icy sidewalks, uneven curbs, bumpy pathways – typically drive personal injury and property casualty claims. But, for insurance adjusters and attorneys, when it comes to determining what caused a fall injury, there’s always more to the story than the weather report and emergency department records.
The challenge when evaluating and analyzing most falls is in determining the validity of the allegation. We ask, Was it really the rain-soaked tiles that caused the fall or could there be another reason — for instance, the claimant’s high heels or a chronic illness — that made the claimant unsteady on their feet? We proceed knowing that not all falls are the same, with each type of fall – from a trip to a slip to a crumple – having its own, distinct thumbprint.
To completely evaluate a fall claim, a thorough understanding of the biomechanics of the fall, a complete story about what happened and a full assessment of what’s inside those complex medical files is vital. Remember that it’s relatively easy to understand why construction workers or retail workers, who are working in unsafe environments or are constantly on their feet, are more likely to fall than other workers. Seniors also are at high risk because they may have lower body weakness, vision problems, foot pain, or use medicines that could make them less sure-footed.
Some questions to always ask and red flags to spot:
- Was an environmental hazard present?
- Focus on the reported description of the fall. Was it a trip, slip, crumple, step up or step down?
- Try and lock down specifically how the person landed. On their buttocks, knee, fall forward, etc.
- What were the primary and secondary impact points?
- Review pre-DOL medical history, especially medications.
But science and experience show us that just about anybody can be prone to a fall for all kinds of reasons – wet flooring, uneven sidewalks or improper footwear. Here’s a closer look at who falls – and why.
As with most things in life, the devil is in the details. The details of the mechanism of injury can often make or break a case.
I was in Seattle recently, meeting with my colleagues in ALFA International, the premier global network of independent law firms. The focus of our meeting was the hospitality and retail sectors…two areas of business that face complex claims and cases where understanding Mechanism of Injury makes a big difference to the bottom line.