(If you are attending the WCCP Board Certification Forum in April in Orlando, please let me know.)
Greetings,
One of the keys to successful defending a WC claim is being able to sort out sooner rather than later what is pre-existing and what is due to the accident. Given the courts recent stricter adherence to the 120-day rule, we really have 120 days from the date of the initial treatment to determine compensability of the claim itself. Anything we can do to speed up that process is beneficial. Most carriers include a medical release for the claimant to sign in the initial packet mailed to the claimant. Follow up on getting that release signed and returned because you can then use it to chase the prior medicals. Your whip on that is they need to return the signed Fraud statement or you can suspend benefits, and just include the medical release in your follow up request.
Often, the initial contact with a claimant can be the most fruitful in learning information about any preexisting conditions. In addition to the obvious questions about whether they have any pre-existing injures or treatment, I recommend asking:
- Who is your current or last primary care or family doctor?
- Have you ever had an MRI for any reason? What body part, and where was it done?
- Where do you get your prescriptions filled if you have any?
You can then send a release to get those records.
ISO searches of prior claims and hospital and pharmacy indexes are also great sources. You can also search directly on the DOAH website for prior WC claims. You can plug in the claimant’s name and las t 4 of the SS# to make sure it is the correct person, and it will pull up prior claims.
https://www.jcc.state.fl.us/JCC/searchJCC/searchCases.asp
I always look at the PFB’s and PFB responses on the prior claims because it often gives the names of the treaters, and you can send the release to get those records as well as the records from the prior carrier. In some cases however, you may not get an MCC defense if the prior injuries are WC, that is a tip for another day.
Of course if you do not get the release back, we can always send subpoenas to obtain the records even before the claimant has an attorney. Let me know if you have any questions.
Be sure to check our website for upcoming CEU webinars for FL, GA and TN: https://eraclides.com/events/
Sincerely,
Morgan Indek | Managing Partner