WHAT TO DO WITH A COMPLEX CLAIM
Some claims are more complex than others. You might have a number of questions you would like answered, but simply can’t determine how to best go about it. There are claims in which there are a multitude of medical issues, but you may not have the expertise as legal counsel or an insurer to properly select the medical specialty (or specialties) that could address the issues. In addition, on some claims there are a limited number of specialties allowed. One might have to choose between, for example, a neurologist or a physiatrist.
Not only is it necessary to choose the correct medical doctor specialty field when handling a claim, but other services as well. You might require the services of an occupational therapist, a vocational rehabilitation consultant, a neuropsychologist, a dentist, or others.
When Should I Refer?
There are other issues as well, such as understanding the proper timing of the referral. Some examples are as follows:
- One would best wait several months before assessing a woman with lower back pain who recently gave birth.
- Depending on the surgery, it is often best to wait before seeing someone after such a procedure until all healing has completed, and preferably after a period of rehabilitation.
- There might be complex family dynamics or psychosocial stressors that would interfere with an evaluation of an individual’s function, such as a death in the family. Due to emotional factors, the assessment might not reflect that person’s usual baseline.
- There could be more than one medical problem that would result in the same symptom complex. An example of this would be intractable headaches following whiplash in an individual with uncontrolled hypertension that could also contribute to headaches.
- Other traumas, unrelated to the index trauma, such as a sports injury after a motor vehicle accident, could contaminate an assessment of causation. If the sports injury was two months ago and the MVA two years ago, it might be best to wait before referring to see if the sports injury improves.
WHAT CAN HIPPOCRATES MEDICAL ASSESSMENTS DO TO HELP WITH THE REFERRAL?
The bottom line is, you want your questions answered as quickly, as accurately, and as cost-effectively as possible. You don’t want to have to send a claimant or client for yet another assessment due to errors or misjudgments made at the time of the initial referral.
Hippocrates Medical Assessments are here to help make your referral appropriate and timely.
Our degree of involvement depends on you and the amount of information provided about the claim. If provided with a brief summary of the claim, we could advise you as a complimentary service. However, if you want a more in-depth analysis of the file, our physiatrist medical director could assist further. Contact us if you would like more information on this service.