Inside Retail Services News

Claims analyst uncovers injury claim unsupported by evidence

Our claims analysts often review claim file cases that show medical inconsistencies that can justify the need for an investigative approach and intense file reviews. They help employers sort out true claims from others that evidence does not support.

Senior Claims Analyst Michele Whinery recently worked such a claim that evidence and medical examination did not support. A retail cashier claimed she had developed pain in her left hand and left shoulder from repetitive lifting, reaching and pulling merchandise on a sales counter.

Michele’s investigation discovered that the employee had a history of making similar injury claims that were disallowed as unrelated to the job. Recent surveillance video showed the cashier performing her required job duties. This demonstrated the tasks were not at a repetitive level and she was utilizing mostly her right arm/hand, the opposite side. An independent medical panel reviewed the video and assessed that her job duties required only minimal use of the claimant’s left arm and hand.

The claim was disallowed. Such an outcome maintains an employer’s workplace safety record that helps to hold down workers’ compensation insurance rates.

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