Doctor Says Injury may be Work-Related, but Is It Really?

It is sometimes difficult to delineate the real cause of common injuries to the knee, back, or shoulders; it is important that we investigate deeply because they can easily turn into expensive workers’ compensation claims.

Quite often, doctors’ medical reports state that the injury might or could be work related but fail to consider the numerous other factors that contributed or may have been the cause of an injury; additional factors include everyday wear and tear, repetitive motion, and prior injuries. When a doctor so much as mentions the injury may be work-related, it is an uphill battle to argue otherwise.

However, in a recent ruling by the North Carolina Industrial Commission regarding a Synergy Coverage Solutions case, the Deputy Commissioner ruled in favor of the employer and denied the claimant’s request for benefits due to insufficient competent evidence of injury. In this situation, the claimant described a compensable trip and fall accident.  Evidence of the fall was confirmed and treatment to the left knee was provided and completed.  The employee later complained of right knee pain which required surgery; this condition was denied and went to a hearing.  Synergy Coverage Solutions was successful in proving that the claimant had changed her story multiple times regarding the mechanism of the fall and the timeline for the pain following the incident.  Additionally, the employee indicated that she had not treated for her knee previously, and Synergy Coverage Solutions was able to prove that this in fact was not true.  Finally, one of the physicians who initially related the injury to the fall, later testified upon questioning that the condition was ‘most likely a gradual process.’  Based on the inconsistencies in the claimant’s story and the testimony of the physicians, the deputy commissioner opined in Synergy and the employer’s favor.

For the employer, this is a significant ruling, as it shows the NC Industrial Commission taking notice of inconsistencies in the claimant’s account of their health and the incident.  Additionally, the Commission is paying attention to the actual injury and the likelihood of it being a result of a compensable incident.  Synergy knows that paying attention to all of these details can significantly reduce the cost of the claim, especially when the Industrial Commission takes a close look at the details presented.

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