Injury Details
What are the claimant's injuries?
neck pain, chest pain, shoulder pain, abdomen pain, headache, knee pain and L wrist sprain
How much wage loss was claimed?
Submitted: 16,744.66 (gross) $14,605.06 (net) *The submitted amount in the evaluation should probably be the gross amount of 16,744.66.
What is our positioning theme?
Soft tissues injuries that have resolved completely within 3 months.
The adjuster put in a significant amount of detail in the authority screen. Was that required?
No. All of this information is found elsewhere in the evaluation screens.
What injuries were put into CIQ?
L wrist/arm sprain, L knee sprain
What tx did they receive?
Treatment:
ER: x-ray of both legs, wrist , cat scan of upper body
PCP: physical exam and referred to ortho
Ortho physical exam and MRI on wrist. Wore a brace for about 2.5 months. Injections
given for knee pain
PT for knee from 11/1- 11/22
How much WL was accepted, and how was it calculated?
Accepted: $9,123.11
Lost Wages: off work from 8/24/22- 12/2/22 - Wage loss coverage on policy.
We owe first five days and remaining balance to make clmt whole as PIP pays a max of $1,000 a month.
Gross wages lost (total claimed): 16,744.66 (68 days @ 8.5hrs/day @28.97/hr).
Deduct 8 days WL not accepted from 11/23-12/2 (1,969.96) = 14,774.70
Deduct PIP payments of 3,370.82 = 11,403.88 gross wages owed.
@80% = 9,123.11 net wages owed
To provide a short, memorable, and repeatable phrase that helps bring a negotiation under control and focused on our overall evaluation.
This claim was initially evaluated on 4/13. What was the primary reason for re-evaluation on 4/28?
CRS learned that 3pc had a $1k monthly cap on PIP WL
What was the allowed tx period?
2-3mo for both injuries
Medical History
Osteoarthritis
Medical History Impact
-history of chronic bilateral knee pain secondary to OA
-has received gel injections and PT in the past that helped reduce pain but had not sought any recent tx for knee prior to the accident.
-ISO- no relevant loss history with inj
What facts are used to support the general damages?
General Damages Impact
Heavy impact. Mechanism of injury is there. Really banged up and bruised. Wore brace on wrist for 2 months (non dominant hand), and received 2 injections in knee. Knee pain worsened by activity, lifting, kneeling, movement, prolonged standing and stair climbing.
What are two of the claimant's strengths?
Severe impact. Total loss. Claimant 0% at fault. Brace worn on hand for 2 months and cortisone injections in knee. Active job and unable to perform normal day to day duties while recovering. No gaps in TX.
What is the impact on lifestyle?
Low
What are two of our strengths?
Made a full recovery with 3 months. PT recommended for wrist but was not completed. history of chronic bilateral knee pain secondary to OA ad has received gel injections and PT in the past that helped reduce pain
When was the initial tx?
0 - 48 Hours
How many negotiation contacts did it take to resolve the claim?
3 (4/18, 5/3 x2)
Any injections?
Yes - multiple steroid.