Workers Compensation
The Workers Compensation system provides temporary benefits, that health insurance does not provide, to medically aid those injured at work and to provide for a quick and safe return to work. Too often, physicians label their patients “disabled” with little understanding of how to assess function. Because an employee is injured on the job does not mean that he or she cannot work. Treating physicians, serving as “patient advocates”, often render opinions that qualify as claim decisions instead of simply documenting medically supported restrictions and limitations (R&L) to provide insurers the information needed to make accurate, informed, and well-supported claims decisions.
TPN’s medical experts are trained and knowledgeable in workers comp cases and know how to focus their opinions to medically supported R&L’s and causally related treatment, enabling injured employees a quicker, safer return to the workplace while reducing risk for employers and insurers.
Many Worker’s Comp claims can become costly and complex to resolve, and as claims become more complex, IMEs and other claim service providers do not have the experts, or in-depth forensic approach needed to determine the causally related injuries and necessary treatment, or to properly assess work capabilities. Only TPN has the proven track record and medical experts in every specialty with experience in worker’s comp cases to help resolve claims involving traumatic brain injury, significant spine or limb injuries, hearing loss, on-the-job injuries involving substance abuse, and co-morbidity injuries that are inherently costly and difficult to resolve.
TPN’s forensic review will analyze the evidence and employee’s medical history, as well as role of any co-morbidities to lay out the best plan of action and medical / investigative experts from our network to help resolve the claim. By understanding the true source of the employee’s complaints and treatment path, patients can safely return to work and cease treatment, ultimately helping our clients settle the claim while greatly reducing risks and unnecessary medical payments.
Our medical experts are highly trained in worker’s comp cases to assess a permanent impairment rating only when the patient has reached maximum medical improvement (MMI), and we adhere to the AMA, ACOEM, and ODG guidelines. TPN can deliver results for these types of Worker’s Comp issues:
- Repetitive motion
- Lower back and neck injuries
- Assault
- Stress
- Death
- Substance abuse
- Carpal tunnel syndrome
- And many other work-related injuries
Working with the TPN team assures our clients get an accurate and in-depth analysis of the employee’s medical reports and prior medical and work history, with physician and mental health professional opinions that support resolution decisions and the claimant’s best path back to work.
Client Success
Challenge
A leading insurer received a claim for a work-related injury involving headaches. The patient worked as a draftsman. It was alleged that his workstation was not properly aligned and caused his neck to be held in an awkward position for long periods of time, resulting in neck stiffness and headaches. For years, the carrier questioned the claim and set up numerous IME’s with orthopedic experts who found nothing wrong with the claimant’s neck to explain the symptoms. Because no other cause was offered for the headaches, the claimant prevailed at numerous hearings and the insurer continued to pay for medical treatments.
Solution
TPN conducted a claim audit and discovered the claimant had a history of previous claims and medical treatments. TPN helped the client obtain relevant and critical information from the plaintiff’s attorney, and upon a forensic analysis of the documentation, TPN recommended a Neurologist expert from their network would be more appropriate to review the case and provide a medical opinion.
Results
Based upon the nature and extent of the patient’s complaints, our Neurologist expert recommended an MRI. The MRI results showed a tumor in the neck area, and our Neurologist was able to provide medical evidence that the headaches were a result of the tumor, not the workstation. The patient was able to receive proper treatment for the tumor, and our client was able to resolve and close workers comp case without any further indemnity payments.
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