Inside Retail Services News

RS analyst reverses questionable injury claim

Our claims analysts sometimes challenge medical claims even when an employer supports an employee who thinks they got injured on the job.

Claims analyst Brigitte Le Vie took a claim in which an office manager reported that she had suffered a repetitive muscle injury due to her work duties. Upon first review in a medical injury guide, Le Vie learned that the stated injury was likely a natural progression of aging, not office work duties. The case reviewed with Labor & Industries included a nurse consultant, medical director and a panel of board-certified doctors who all agreed that the injury was age-related degeneration.

Had the claim been allowed to include surgery, the employer’s safety record would have included a finding of permanent partial disability that can result in higher workers’ compensation insurance premiums.

Our seasoned staff of claims analysts weighs evidence from employees, employers and medical professionals to determine the best possible outcomes. We regularly work to benefit employers when claims cannot be medically justified.

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