Today’s post comes from guest author Thomas Domer from The Domer Law Firm in Milwaukee. Although Nebraska doesn’t require a “single incident or episode” like Wisconsin, the terms “trauma” and “traumatic injuries” most definitely mean different things to different people. Context matters, and most injured workers don’t have a lot of experience with medical terminology and what it means. The legal profession has its share of jargon, but that’s part of the job of an attorney and their staff – to help clients navigate through both the jargon and process of their claims. But I agree with Mr. Domer that it would be much more helpful to injured workers if doctors spent a quick moment explaining what their jargon – especially using words like trauma – really means in the context of a work injury report.
I’ve been investigating Wisconsin and national fraud statistics in worker’s compensation to prepare for a national presentation I am making in Cape Cod in July. One fascinating and recurring basis for denial of worker’s comp claims (and potential claims against employees for fraud) stems from an insurance carrier’s review of the initial medical report.
Often the physician or emergency room nurse, physicians assistant or First Responder will ask an injured worker “Did you have any trauma?” If the answer to the question is “no”, the medical records will routinely indicate “no trauma”. This information is translated by the insurance carrier as a denial that an injury occurred. The level of medical sophistication for an injured worker is routinely limited. Most of my clients (and based on inquiries with other workers’ attorneys, their clients as well) believe a trauma is something akin to getting hit by a bus. They do not equate the notion of trauma with lifting a heavy object such as a table or a box. The criteria for traumatic injuries in most states, including Wisconsin, is that a single incident or episode caused the injury or aggravated a pre-existing condition beyond a normal progression. In many cases a lack of “traumatic injury” at the initial medical presentation is not an accurate indication of whether a traumatic injury actually occurred.