Greetings, by special request, here is a Tip on how to handle a new accident that occurs after the open WC claim.
- How to find out if there has been any new accidents – Sometimes, the claimant will actually mention a new accident to the treating doctor, so be sure to read the narrative notes. Additionally, you can always run an updated ISO search. If the claimant is not represented, you can call and take an updated statement any time during the claim. If there is a pending PFB, your defense atty can take an updated deposition and cover all issues in addition to ask about new accidents. Social media searches will also sometimes reveal the claimant has been in a new accident.
- Impact on compensability – Well it depends on when and where the new accident occurs. Unfortunately, the caselaw states that any car accidents on the way to or from authorized treatment or injuries during PT treatment are compensable as part of your claim. A new WC claim while on light duty for your employer would be a new claim.
If there is a new non-work related accident, your first step is to determine whether there is a new injury or aggravation to the compensable body parts you are already treating. Regardless, try and obtain the records from that new accident either via a signed medical release or your defense attorney can send a subpoena to see the extent of the new injury.
If the claimant is unable to do your light duty job because of new restrictions from new unrelated accident, you can deny TPD as long as the light duty job would have remained available. Arguably, if their car is inoperable after the new accident and they cannot attend your light duty job, you could also deny TPD.
- Handling strategy -We are only responsible to provide treatment as long as our original accident remains the major contributing cause per 440.09.
The best practice is to obtain the new accident records, and present them to the treater for an opinion on whether or not your claim remains the MCC. This can be done by sending the record to the doctor with an MCC letter or having the NCM or defense attorney conference with the doctor. (Just as an aside, a signed letter you create for the doctor’s signature or even an addendum written by the doctor outside of an office visit are not admissible medical records. If possible, I ask the doctor to address MCC in their next office visit note in addition to signing the letter now otherwise we have to take a depo)
Sometimes, you may have clear enough evidence of the new accident that you can deny pending the clarification from the doctor on MCC and sometimes you might need to await the doctor’s opinion. That is a strategic decision to be discussed with defense.
Also, if the new accident is unrelated to work, there are no subrogation rights under your original claim.
As always, please let me know if you have any questions!
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Sincerely,
Morgan Indek | Managing Partner