by Lenin V. Perez
When the Office of Workers Compensation (OWCP) accepts claims, many times they accept the claims as contusions, sprains, or strains. The injured worker then becomes excited because now they will get paid benefits instead of realizing that this acceptance should immediately raise a red flag. It should cause concern because contusions, sprains, and strains resolve quickly. The next step after claims acceptance is the claims examiners will set up a second opinion physician examination and send them a Statement of Accepted Facts (SOAF) asking the doctor if the contusions, sprains, or strains have been resolved. The second opinion doctors will surely say these conditions have been resolved.
These tricks are played by the claims examiner and should be taken seriously. If they receive this type of claims acceptance, the injured employee should immediately go to their medical provider and update their medical diagnosis to the conditions that the injured worker really has and then include the medical test(s) to prove the diagnosis. For example, the injured worker had the claim accepted as a sprain of the lower back but actually has a herniated disc of the L4-5 vertebrae. The next step is for the injured employee to obtain a medical report from the doctor detailing the herniated disc and then get medical tests which support the report and diagnosis.
The definitions of contusion, sprains, and strains are as follows:
Contusions are simply bruises of a certain part of your body. One must be aware that a bruise will not last forever, and, in fact, is a short term problem. I have seen a knee injury accepted as a contusion. In this case, the worker unknowingly sustained an injury which required knee surgery, a surgery which should have been paid by the Department of Labor. The doctor inaccurately diagnosed the injury as a contusion. One year later the employee was sent to a second opinion doctor, and the doctor was asked if the contusion had resolved itself. The doctor’s answer was, of course, yes, and the injured worker’s case was then closed – the employee still requiring the surgery for the incorrectly diagnosed knee injury. The worker eventually discovered and was diagnosed with a torn meniscus of the left knee. In this case and cases like it, the injured worker should forward to the claims examiner the most recent medical report discussing the knee injury and the MRI test results and nerve conduction test results which support the updated diagnosis.
Sprain means to wrench the muscles or ligaments around a joint without dislocation. There have been many cases where the claims examiner accepted the condition of a lower back sprain when injured worker’s real condition is a herniated disc of the L4-5 vertebrae. In this case too, the injured worker should update their medical diagnosis to herniated disc at the L4-5 vertebrae with a medical report and all tests that were performed to help arrive at the proper diagnosis.
Strains are weakening of the muscles by over exertion or to stretch the muscle beyond the proper limit. The claims examiner accepts the injured worker’s condition as a strain of the right shoulder. However, the real diagnosis should be a right shoulder rotator cuff tear. The injured worker needs to upgrade this condition in the same manner as the prior examples.
Most claimants and their medical providers are so excited that the claim has been accepted that they do not pay attention to the accepted condition and the related danger that the claim is accepted for the wrong diagnosis. The injured worker and their medical provider must perform all tests that are necessary to prove a proper diagnosis. They should also be very persistent in having the condition properly accepted for what the claimant’s condition and diagnosis really are.
Ensure that you pay close attention to the accepted diagnosis for your injury once received. If you see the accepted condition(s) as contusions, sprains, or strains, you now know that these are warnings which in the near future could create problems with your claim(s).
Call Federal Workers Compensation Consultants today for a free initial consultation at 813-931-1984
Federal Workers Compensation Consultants
Workers Compensation and Disability Retirement Specialists
9639 N. Armenia Avenue
Tampa, Florida 33612
Se Habla Espanol – 813-931-1984