I am very proud to say I work with workers’ compensation adjusters on a daily basis. One of the most important aspects of my career is to aid those individuals in their respective medical dictation so that they are enabled to do the best possible job as workers’ compensation professionals. Having a competency in the basics of medical knowledge plays a crucial role in investigating the claim, handling the claim, interacting with medical professionals, and ultimately resolving all applicable issues. There must be a solid understanding with respect to medical terminology and applicable concepts in treating injuries.
As part of my career, I have had the opportunity to provide educational lectures to workers’ compensation professionals who are maintaining their licensure via the continuing education process. One of the thoughts is a summary of surface anatomy so that these individuals know the difference between the scapholunate ligament and the sciatic arch. Additionally, noting the location of certain pieces of anatomy can markedly assist that worker’s compensation professional and aid in judging the relatedness of all complaints offered to the compensable event. Having a certain level of medical knowledge allows worker’s compensation professionals to interpret medical reports, diagnostic assessments, operative reports, and treatment plans. These informed decisions allow for as rapid an adjudication as possible, and all appropriate care being rendered for the compensable injury sustained.
Added benefits of this medical education enable effective communication with all members of the healthcare team providing care, as well as assisting in the development of appropriate questions so that any issues can be resolved quickly. This knowledge also helps in recognizing potential issues and inappropriate expansion of the except a compensable injury. This knowledge enables the deployment of appropriate red flags, when necessary, particularly if there is an issue of fraud or other similar problems.
Having this knowledge can contribute to or effectively streamline a settlement process that is proper for the jurisdiction. Moreover, any evaluator who accepts all of the complaints offered by the injured employee may be hoodwinked into believing that the accepted compensable injury includes those items which have been excluded and this point is easily understood by the client file handler with appropriate medical knowledge.
Lastly, having this medical knowledge is a significant asset when negotiating the culmination of the claim. Having an understanding of the long-term consequences of the pathology noted assists in what is a reasonable request. An injury that results in a compromise of the articulation of a joint almost assuredly will develop into an arthritic situation and depending on the joint could result in a total joint replacement. A significant concern in the overall settlement process.
In short, having this medical knowledge is a fundamental requirement for every claim professional involved in handling these issues. Knowing the terminology, the anatomy, and the right treatments for such injuries allows for a thorough investigation of the claims, effective communication with the claimant and healthcare providers, and can work towards preventing fraudulent claims, as well as improving settlement efficiency. I would encourage everyone to seek out and obtain as much medical knowledge as they can absorb, to become a well-rounded worker’s compensation professional.