Friday, January 27, 2012

Causation


An injury can be confusing for patients, doctors, insurance companies, attorneys claims adjusters and others involved with the injury.

What is the injury or diagnosis?
Was care needed related to the accident?
Was treatment or testing appropriate?
Was the injury caused by the accident?
What is the long term prognosis?
Was this condition pre-existing?
Is the claimant really injured?
We answer these and many other questions to the injured, insurance companies, attorneys, doctors, and claim adjusters. In today’s healthcare environment there is a growing need for outcome based measures to control cost and promote quality based care and testing. Theses services are based on nationally recognized guidelines such as the AMA Guide to the Evaluation of Permanent Impairment, Social Security Resources, AMA Guide to the Evaluation of Disability, Croft Guidelines, The Quebec Task Force, and other professionally accepted guidelines.


5 basic steps to determine causation in an injury claim.

1. Symptoms – What are the complaints?
2. Diagnosis – What is causing the symptoms?
3. Clinical Correlation – Do the symptoms and findings match the diagnosis?
4. Causal Relationship – Did the accident result in the diagnosed condition?
5. Apportionment – Are there any other causes or contributing factors?

Once a causal relationship and a diagnosis are established the other aspects of the claim can be reviewed. These steps should be followed in order and apply to all injuries (regardless the treatment or the type doctor caring for the claimant). They are universal and considered the gold standard for determining causation.

2 comments:

seattlechiropractor.com said...

Even if your auto accident seemed minor because of slow speeds or little damage to your vehicle, that doesn't mean injury did not occur. At just 10mph, the body can be subjected to a force of 5 to 10 G's. The force of 10 G's is greater than a fighter pilot would experience during aerial combat.
Independent studies show that your body can violently move back and forth 6 to 10 times the speed your auto was going at time of impact. In other words, a 5-10 mph crash, your neck can move at 50 to 100 miles per hour! This is how G force can cause serious injuries at even low speeds.
Even those involved in low-speed accidents should see their chiropractor to rule out a whiplash injury that, if left untreated, can have ramifications for years.

Christopher Connelly said...

Agreed but the claimed injuries need to be causally related.