| Q. | What kind of information can I expect from a background/activity check? |
| A. | A background check can reveal a claimant’s criminal history, business licenses or self-employment, prior injuries/motor vehicle accidents, any previous claims, activities or hobbies, and bankruptcy’s or other financial troubles. The objective and tangible nature of these findings can be extremely valuable in the claims management process. A drive-by of the claimant’s residence can also be helpful is deciding whether surveillance would be appropriate. |
| Q. | When should I get a statement on a claim? |
| A. | There are a variety of reasons to obtain a statement early in the claim process, such as: On a back claim, or a strain or sprain where the time loss exceeds about 40 days, you should consider scheduling a statement. You may find a statement useful on a back claim even if it appears to be resolved. Often times, the statement proves useful at a later date if an individual files a reopening application or a new claim for another injury. Statements can also provide a good foundation to base decisions on future investigative action on. |
| Q. | I have a claim that certainly seems to be a valid claim. There were several witnesses, and the claimant had to be taken to the hospital emergency room in an ambulance. Why would I need a statement on this type of claim? |
| A. | A claimant statement can be useful for many reasons other than when someone questions the claim. It can provide you with information related to a pre-existing impairment of the same body part from a previous injury (even one that was not listed on the claim form), or it can alert you to possible problems that have surfaced since the time of the initial injury. The information can be submitted for an independent medical examination, and may also be used to communicate with the attending physician when you suspect that the course of treatment may not be the best for the claimant. |
| Q. | I would like more information but do not want the claimant to think that I question the claim. If I ask for a statement, won’t the claimant become apprehensive? |
| A. | Not usually. Sometimes there is some apprehension when the claimant is first contacted, though this can easily be overcome by the attitude of the investigator prior to the interview. A confrontational setting is not very conducive to obtaining a good statement and will be avoided. At first contact, the investigator begins to build rapport with the claimant and is frequently viewed by the claimant as an advocate for them by the conclusion of the statement. |
| Q. | How can a claimant statement be used to help an independent medical examination? |
| A. | There are several factors that are covered in the claimant statement that should be considered by the IME panel. There will be a good description of the mechanical process involved at the time of the injury, as well as the symptoms that were present initially and those, if any, that have continued. In the event of an in-person statement, a detailed account of the current symptoms and physical conditions of the claimant during the time of the interview will also be included in the report. This includes how the claimant moves, sits, bends, as walks, and also their demeanor, when appropriate. This information can be used and evaluated by the IME panel to aid in their conclusions. |
| Q. | I have a claimant with a minor injury that keeps recurring. I don’t understand how an injury of this type can be attributed to the circumstances that were reported, but the employer feels that the claim should be accepted because the claimant is honest and hasn’t lost any time as a result of the injury. What could a statement do for me on this type of injury? |
| A. | This is a tough judgment call. We are aware of many claims in the past, however, that were initially misdiagnosed by the physician simply because they did not have enough information when they saw the injured worker. We have been able to develop this information during the interview.
An example of this injury type would be tendonitis or carpal tunnel syndrome of the wrist without supporting EMGs. Cervical injuries can frequently cause symptoms affecting the shoulder, arm, elbow, wrist, and/or hand, and are commonly misdiagnosed as tendonitis or overuse syndrome. If an IME panel is made aware of a cervical injury and asked to consider that information, it may result in a diagnosis that is more accurate and allow for proper treatment of the claimant.
Another type of misdiagnosis would be a previous foot or hip injury that had caused the injured worker to walk in a manner that would place undue stress on the knee. While the knee injury may be very real, the cause may be related to a prior injury that would be the responsibility of another party.
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| Q. | One of my claimants denies any previous injury of this type when asked and also on the accident report form. How would a statement help in this instance? Wouldn’t the claimant simply continue to lie to you? |
| A. | If your claimant is lying, then you should probably expect that he would continue to lie during the statement. However, there are several points you might want to consider in this situation. For instance, the claimant might not be lying; rather, he may not believe that the previous injury is in any way related to the current injury. A statement can help develop this information. On the other hand, if your claimant is obviously being untruthful and continues to lie during the statement, different types of investigation, such as a background check and/or medical record retrieval, can be used to develop further information to either verify or refute the claimant’s reports. |