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The Claims Management Reality
CASE HISTORY # 1
CLIENT: CONSTRUCTION COMPANY
CLAIM: INJURED BACK
Employee files a Worker’s Compensation claim that he injured his back while moving a pipe valve on the construction site. He receives medical services from a treating doctor and the medical bills are submitted to the carrier.
As part of our program, we require copies of medical bills and a doctor’s diagnosis. Upon review of the diagnosis, we discovered that the claimant had been treated for a polynoidal cyst…an infection and inflammation that was the actual cause of his back pain, not the result of a work related accident.
On our recommendation, the client informed the insurance carrier and the claim was determined to be non-compensable.