When the going gets tough with our Workers’ Comp Retro Group member claims, Vigilant digs in.
Take the case of a worker at a Washington manufacturer who suffered a full rotator cuff tear on his right shoulder. Two surgeries, two years, and more than $100,000 in claims cost later, another claim was filed for a tear to his left shoulder—just as the first claim was ready to close.
Frustrating and expensive, for everyone. The manufacturer was looking at two years of retraining, lots of additional medical treatment, and the impact of three more years of claim costs on their experience modification factor.
New Independent Medical Exam & Employee Declaration
After two years of managing a difficult and expensive claim, the last thing Vigilant or the manufacturer wanted was a new claim with an additional three years of exposure and high additional claim cost. That’s when Vigilant’s strategy kicked into overdrive. Our claim manager on the case went the extra mile. He not only insisted on a new independent medical exam, but helped procure a written declaration from the employee, detailing the facts of the new injury. The document from the injured employee stated that the new injury was due to overcompensating from the original injury, and wasn’t triggered by any specific event. The employee had been performing light duty work at the time the alleged second injury occurred.
The combination of the employee’s written statement and the results from the new MRI exam were enough for L&I to decide that the new injury was a “progression of natural degeneration, and not the result of any industrial injury or occupational disease.” The new claim was denied.
Case Closed, $167,000 Saved
Because the injured worker has a physically demanding job, the additional surgery would have resulted in time loss, medical expenses, and potential retraining costs. Thanks to Vigilant’s persistence, the manufacturer and the Retro group saved approximately $167,000 in claim costs. Not only that, but the original claim could move forward to closure.
When one of our Retro Group members is facing a particularly drawn-out and expensive claim, sometimes it takes thinking outside the box to get the best outcome. That could involve asking the right questions, talking to the right people, or getting that additional medical exam. Our claim managers cross every “T,” dot every “I,” and look for inconsistencies as they are working the claim and moving it forward. Our job is to ensure you only pay for the claims you are responsible for, and not a penny more.
It takes tenacity. Let ours start working for you. Contact Vigilant today.
This website presents general information in nontechnical language. This information is not legal advice. Before applying this information to a specific management decision, consult Vigilant or legal counsel.