Lt. Daniel Kaffee, as portrayed by Tom Cruise in "A Few Good Men", once said, "It's not what I know, its what I can prove." Nowhere is that statement more applicable than in workers' compensation claims, where common sense is can be drowned out by legal gamesmanship.
I was recently on a mediation docket in Kansas City, Missouri where I had the exact same issue in TWO different cases. In each one, the worker had suffered repetitive trauma injuries due to her everyday work activities. This resulted in pain and numbness in the hands and fingers. In both cases, authorized treatment was provided to their hands and wrists. In addition to these symptoms in the hands and fingers, each client was suffering from neck and shoulder pain. The problem for us, however, was that the medical records did not mark the first complaints of neck and shoulder pain until after the clients had been off of work for several weeks. In both cases, the neck and shoulder treatment was then denied by the insurance carrier since the related complaints started while the workers were off work. That's when they called Haight Stang LLC.
What do we know? We know that the neck and shoulder complaints started at the same time as the hand and wrist complaints and were caused when our clients performed the repetitive work. We know that the repetitive work in each case was the type that would cause injury to the neck and shoulders. We know that there could be no other cause for the injuries to the neck and shoulders because no similar activities were being performed outside of work. It stands to reason that whatever caused the hand and wrist injuries, caused the neck and shoulder injuries as well, right?
Wrong! Remember, it's not what we know, it's what we can prove. Of course, in order to prove something, we need to have evidence. To a large extent, workers compensation insurance companies have taken the position that, "If it's not in the medical records, it didn't happen." So at this point, the only thing I can PROVE is that the neck and shoulder complaints STARTED a few weeks after both workers stopped performing any work for their employers. Between what a client later says they told the doctor and what is actually documented in the records, the records will win out almost every time.
In talking to both of my clients, one said that even though the neck and shoulder complaints were present early on, the hands and wrists were the priority, so she figured she would deal with the other problems after her hand and wrist surgery. The other actually talked to the claims representative about her complaints but was told those complaints would resolve after her hand and wrist surgery. When asked about that conversation, the claims representative had no recollection of the discussion. Shocking!
Now, both cases are headed towards trial which may have been avoidable. What would have prevented this additional delay and hassle? Had both workers mentioned those complaints early on, it is doubtful that the insurance company would have even blinked at providing this additional treatment. But now they have a hook to hang their denial on. I don't think they will win, but they have succeeded in delaying benefits to both of my clients who legitimately need and deserve them.
Moral of the story: Make sure you have every complaint documented starting from the very first doctor's appointment. Be thorough and be consistent. Even though you and I know what caused your complaints, we still have to prove it. And the insurance company CAN'T HANDLE THE TRUTH!