Workers’ compensation provides valuable benefits to employees injured on the job by covering all their medical expenses related to a workplace accident while also providing wage replacement. Employees covered by workers’ comp cannot sue their employer or a co-worker for negligence even if those parties were responsible for causing the accident.
Why Workers’ Compensation Claims Get Denied and How OnPoint Legal Nurse Consulting Can Help
Workers’ compensation claim denials often center around the claimed injury. Just about any on-the-job injury should be covered by workers’ comp, but when employees make a claim, the response from the employer’s insurance carrier is often one of the following:
- The claimed injury is due to a pre-existing condition
- The injury occurred outside of the workplace
- The claimed injury is exaggerated or non-existent
OnPoint can help you refute the insurance companies’ arguments and prove the worker’s case. With a thorough review of medical records, we can demonstrate whether or not a pre-existing condition appears in the patient’s medical history and provide expert opinions on whether it is relevant to the case. We work with qualified experts experienced in workers’ compensation cases who can opine on how a particular injury occurred and whether that injury is consistent with the employee’s occupational tasks or a particular accident.
We can connect you with an expert to conduct an independent medical examination (IME) when you and your client disagree with the examination ordered by the defense. In addition, our experienced nurses can appear with your client at any Defense Medical Examination (DME), serving as your eyes and ears during the exam to give you a firsthand account of what transpired and provide comfort and support to your client. IMEs/DMEs are a favorite tool of the insurance company to deny claims initially or terminate benefits before the employee is ready to go back to work and the insurance carriers demand them as often as the law will allow.
OnPoint Can Help You Settle Your Case or Craft an MSA
Medicare requires that a Medicare Set Aside (MSA) be submitted in workers’ comp cases, documenting workers’ compensation as the primary payer and securing Medicare’s status as a secondary payer. Our certified MSA providers have a thorough understanding of what is required to consider and protect Medicare’s interests. We’ll prepare the MSA report as required and submit it to CMS on your behalf.
Life Care Plans
If you have a client with a permanent disability, OnPoint provides comprehensive life care plans by certified life care planners to help you settle the medical component of the case in your client’s best interests and ensure that important factors and costs have not been overlooked.
Call OnPoint Legal Nursing Consulting for Help with Your Workers’ Compensation Case
For assistance with medical expert witnesses, independent medical examinations, medical record retrieval and analysis, trial exhibits, and more, call OnPoint Legal Nurse Consulting. From our office in Philadelphia, we work with attorneys throughout Pennsylvania and New Jersey and we are also active in Florida and locations across the United States. Call now and expect a quick response from our dedicated team.