Note Type
Call to Opehlia Payne at 888-999-1010 Left message introducing myself and requesting return call regarding her 02/09/2010 DOI.
What is Claimant Contact?
Call to YouShoesyouloose location 444-864-2131 spoke with Store manager Jed Dye. He stated the employee returned to work today 03/21/21 full duties. He is not aware of any other information regarding the claim and will have manager Justin Case call me with further information.
What is Employer/Insured contact?
This is the note type you would use when providing an overview of litigation to date or to document no litigation in your initial date integrity note
What is Litigation?
LOV: 4/19/2024
NOV: 5/20/2024
Dx: Bulge of lumbar disc without myelopathy. Bilateral groin pain. Lumbar strain
Work status: Released to return to work with restrictions that cannot be accommodated. No bending, climbing, crawling, driving, kneeling, squatting, twisting. Can lift, push, pull up to 5 pounds. Can walk and stand as tolerated.
Dx test: 1/11/2024 Groin, Right US No discrete hernia. 1/11/2024 Lumbar MRI disk bulge superimposed HNP and radial tear L1-2 and disc bulge and radial tear at L3-S1. New changes is spinal stenosis at L2-3 when compared with previous MRI February 2023.
Surgeries: None
FCM assigned: None assigned
What is Medical Management
4/13/2021 Northwest Community Immediate Care 847-618-9655
48yr old male presented to ICC toady to with bilateral upper arm pain which started 3 weeks ago. no injury or trauma but does heavy lifting at work. pain worse with lifting
What is Medical report review?
Worksheet sent to Stanley Cupp with client for approval:
Future Indemnity: Requesting 26 weeks of TTD to pay wages post-surgery 10/5/2024. Total increase: $6,999.20
Medical Treatment: Requesting increase of $160,200 for the 10/5/2024 right hip fracture repair surgery and post op treatment including inpatient hospital/rehab stay, surgery costs, office visits, durable medical equipment, physical therapy and post-operative diagnostic studies.
Expenses: Requesting increase of $28,000 to cover PPO/medical bill review costs, medical copying fees, and medical case management costs.
Total Request: $195,199.20
New total incurred: $204,573.70
What is Reserves?
This note type is for an item you must request and receive this from defense within 30 days of assignment and then quarterly
What is a legal budget?
Request sent to employer Kim Sanchez with Tek Corp for wages for 52 weeks prior to the 04/06/2021 DOI
What is AWW/Comp rate?
CSR sent to Betty White with Golden Girls Co-op and copy to file next CSR due in 90 days
What is Client Status Report?
Request sent for clerical to sent new claim packet
What is Claimant Contact?
AWW: $491.68 AWW Rate: $327.79 PPD Rate: $295.01
Received wage history. Year prior: $16225.39 without OT $18445.13 / 33 weeks worked = $491.68.
What is Aww/Comp rate?
This claim is not excess reportable as it does not meet reporting criteria at this time. Retention level is $2mil and reportable at $1mil as set forth by Indemnity Insurance Company of North America.
What is Excess?
Letter of representation received 9/1/2024 from Curtis McPhail, Bickers and McPhail PLC, 1095 Redline, Chicago IL 60663, 773-648-2131 C.mcphail@BMattorneysatlaw.com
What is Claimant attorney?
Any correspondence (including letters, emails, phone calls) with Defense counsel would be included under this note type.
What is Litigation - Defense Strategy?
Jurisdiction: Pennsylvania claimant lives, works in and injury occurred in PA
What is State/Regulatory Forms?
Adjuster response to supervisor review:
Correct the errors on the RTW screen-Done
Update the OSHA screen with the providers information-Done
Call the provider to obtain the next appointment date and update the file accordingly. Task set
What is File Review?
Is the employee a covered class under this policy?
If Large Deductible customer: note carrier, reporting requirement, and deductible:
If Self-Insured, mark as such if excess applies no reporting requirement and SIR:
If excess applies, note reporting requirements and SIR:
What action to take if no coverage/declination?
Job class code number:
Policy number and begin/end dates:
Jurisdiction:
What is Coverage/policy?
Sent request to CA requesting IND TNCP
Weekly, Monthly, Biweekly payment? Bi-weekly
Jurisdiction Number 9233435
Part Of Body 61 Abdomen
Nature Of Injury 10 Contusion
Cause Of Injury 74 Punched by resident
Narrative/description: Feeding a resident when he punched her stomach.
What is State/Regulatory Forms?
File review with client (name parties present) 10/2/2024 Provided update at claim review. We are currently waiting on IME report and will move forward once that report is received and reviewed.
What is File Review?
Defense counsel assigned, auth provided by client for same 03/16/21 Quilliam T Nibbles, Hedgehog and Whistlepig LLC, 333 Over the Hill Lane, Adventure MI 47321, QTNibbles@Lawforone.com
517-124-6791
Confirmed that PC is on approved list with employer and carrier.
What is Defense Attorney?
Report sent to Cy Nara (cy.nara@xsinsurance.com) XS Insurance Carrier 10/02/2024, copy to file, next report due by 1/2/2025. Task set.
What is Excess note?
Email received from Story Teller (steller@deweycheatemhowe.com) indicating they now represent the claimant and we should have no further contact.
What is Claimant attorney?
CCRX closed: Yes
ISO reports stopped? Yes
Address permanency? Yes 0% (there is no perm in this jurisdiction)
All known medical bills paid: Yes
MMI date: Claim denied
Exposure for future indemnity benefits: No
Subrogation resolved, if applicable? N/A
Outcomes tile updated in RTW Module (NO errors)? Done
State forms: PA - 496 filed 6/21/2024
Why recommending for closure at this time? No further action necessary at this time.
What is Closure?
Use this note type code for Witness contacts, to address fraud, and Occupation
What is Investigation?
Reviewed ISO report
7/2/2016 WC finger lac
11/18/2023 Auto No injuries noted
No matching claims – no follow up required
What is ISO Claim Search