Filed Under:Risk Management, Corporate Risk

Whiplash Derby: 10 Red Flags to Look for in Claims Fraud

A minor accident should not result in serious injury or prolonged care claims. (Photo: iStock)
A minor accident should not result in serious injury or prolonged care claims. (Photo: iStock)

For motorists, the National Highway Traffic Safety Administration has good news and bad news.

According to a March 2016 report, there were 219 fewer fatalities from motor vehicle crashes in 2014 than in 2013 — part of an ongoing decline since 2006. But the number of people injured during a car crash is on a slight uptick. In 2014, 2.34 million people sustained injuries in a motor vehicle accident. In 2013, the number totaled 2.31 million.

While the increase in injuries is considered “statistically insignificant,” the boost represents thousands of patients, countless insurance claims and a bevy of complaints about sore necks and bad backs.

Of course, many injuries from automobile collisions are severe. But, when the accident is a “minor impact collision,” studies have shown that occupants are unlikely to suffer longstanding injuries. The treatment time and length of the open or unresolved claim, however, can be protracted and may involve plaintiff counsel.

Psychological factors, in fact, might be behind most complaints of chronic pain after a minor collsion according to a report about the biomechanics of minor automobile accidents. In fact, researchers have found that claimants complaining of whiplash get better more quickly if they don't have access to compensation for pain and suffering.

As you review records from a minor crash, there are plenty of red flags that could signal big problems.

Here are 10 red flags:

1. No damage, but significant injuries

The vehicle suffered very little damage, but the patient complains of significant injuries — or offers multiple variations of physical complaints.

2. Extended care

The patient seeks extended periods of chiropractic care, physical therapy, acupuncture and pain center treatments before seeking help from an orthopedist, an evaluation from a neurologist or an assessment from another medical specialist.

3. Ongoing treatment, with no specialist

The patient undergoes ongoing treatment from a family practitioner or primary care physician, but does not seek treatment from a specialist.

4. MRI, CT scan T

The patient undergoes high-level diagnostics immediately. Remember: An MRI, a CT scan and similar tests should be done to confirm or rule out a condition — not as a fishing expedition.

5. Prior problems

If a patient undergoes surgery or is hospitalized after a minor collision, it may be an indicator of prior health issues or problems or conditions that pre-date the accident.

6. Compare, contrast

Compare the billing statements against the narrative records. Missing records are a red flag.

7. Examination required

Carefully review the mechanism of injury throughout the medical records. Any ongoing changes and embellishments are a red flag.

8. Unusual injuries

Shoulders and wrists are usually not injured in a minor collision. If there was no head trauma, any alleged neurological, cognitive and learning losses should be thoroughly investigated.

9. No advanced treatments

If injections, discograms and other more advanced treatments and diagnostics weren't ordered, it's likely the injuries were minor. Doctors usually try to avoid these tests and treatments as they carry potential risks and complications. Additionally, advanced treatments should be supported by diagnostics and objective findings.

10. Degenerative findings

If radiologic studies found significant degenerative issues, these evolved before the motor vehicle accident because of old age or other factors. Exacerbation or aggravation can occur, but there should be a return to the baseline.

Medical records can reveal a lot about the severity of injuries after a car crash. And, if the vehicle received only minor damage, a trained eye can uncover the discrepancies that would rule out a major injury. Red flags and savings can usually be found if you just know where to look!

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