Greetings, by special request, this Tip is on how to handle a new accident that occurs after your claim.
How do we find if there has been a new accident? Sometimes we discover the claimant has had a new accident from the claimant telling the provider in our claim. Always check the narrative notes. You can also run an updated ISO claim index for claims that have been open for a while to see if there are any new insurance claims filed by the claimant. You can also do a search on DOAH for litigated WC claims. If you haven’t spoken to the claimant in a while, you can always call (if they don’t have an attorney) and ask if they have been in any new accidents
Just by a claimant having a new accident does not mean you can deny future benefits in our claim…yet. We need to build the defense that “the accident does not remain the major contributing cause of the current condition, need for treatment or disability”.
If the claimant is in a non-work-related accident after your claim, run the ISO to find the carrier and providers. If you have a signed medical release, send off for the records. You can always assign it to defense (our firm obviously 😊) for the limited task of sending subpoenas to obtain the records. If the claimant is not represented, you can call and take a new statement and find out about the new accident, providers, and so forth.
Once you get the records, put them into a neat and tidy composite for the doctor. Put them in chronological order, take out duplicates etc…Draft a clear and concise cover letter, pointing out what you want the doctor to see in the composite, and ask for them to draft an addendum addressing ongoing MCC. You can always have them check boxes and sign an MCC letter. (Neither an addendum not done as part of an visit or the checked MCC letter are admissible before the WC Judge, we would eventually have to take a depo of the doctor).
It is a bit messier if it’s a new WC claim for a new employer. You can take the same route to get the records to the doctor, but because both claims are WC, you do not get an MCC defense. You either have to get the doctor to state no further care at all is medically necessary for your claim or file a Motion for Contribution to bring the other carrier in to your claim to help defray some of your exposure.
Always be on the lookout for “sequelae claims” that stem from your claim. These could be an MVA on the way to a doctor’s appt, the claimant getting reinjured in PT, a fall due to your injuries, etc…these could be compensable extensions of your claim.
And lastly, there is always the potential for a 440.105 Misrepresentation claim if the claimant is not honest about the new accident. This would have to be an oral or written statement that was not true, simply not telling anyone, if not asked, is not enough.
We are always available to help you strategize!
Upcoming events and CEU’s:
- Tampa -7/31/26 for our 11th annual CEU/Dinner, RSVP to EG@eraclides.com or let me know.
- Orlando- 8/4/26 for a CEU/Live Surgery at Jewett Orthopaedic/Orlando Health, come meet the doctors, watch a surgery and CEU roundtable, to register and for details: https://events.blackthorn.io/en/5e14dFD7/live-from-the-or-5a64PmJ25DZ/overview
- Check our events page for more Webinars and events: Events from June 30, 2015 – September 10, 2015 – Eraclides Gelman
Sincerely,
Morgan Indek | Managing Partner