When determining the compensability of an occupational disease claim, an extensive investigation is required. In addition to determining the immediate cause of a disease, a thorough investigation should include identifying any potential underlying and root causes.
Through the identification of the underlying and root causes, many times steps can be taken by the employer for prevention of future claims.
Preparations for an Extensive Investigation
Good investigations start with gathering information. Within 24 hours from when the claim was filed, a three point contact should be made with the following to collect information and records:
-
Employers
-
Employees
-
Medical Provider
An important aspect of reviewing these claims is having an understanding of their entire medical history, not just the medical records from the injury or claim.
By definition, occupational disease is a disease contracted as a result of exposure over a period of time or a disease that is caused or made worse by occupation. Therefore the person’s entire medical history should be reviewed, not just a short period of time.
Extensive Investigation of Potential Underlying and Root Causes
During the review of the information and records gathered including the employee’s complete medical history, the factors below should be considered to help identify any underlying and root causes. This information will assist in determining compensability.
#1 – Does one or more pre-existing conditions exist?
Something in the work environment could have aggravated a pre-existing condition such as asthma or allergies.
#2 – Do they have a 2nd job?
An employee may not want to admit they have a 2nd job, especially if that job is “on the side.”
#3 – What previous jobs have they held?
In addition to what company and position the employee held at a previous job, understanding what location(s) the employee worked at and what their particular responsibilities were are key factors to consider.
#4 – What prior and present outside activities or hobbies do they have?
There are an unlimited number of activities and hobbies an employee may have participated in over a long period of time.
#5 – What medications are they taking?
Both prescription and over-the-counter medications including supplements can cause certain conditions.
#6 – What are they posting on social media?
Employees may post information to social media sites such as Facebook that the employee does not mention during their interview.
#7 – Have there been any changes in the work environment?
Did the employer bring in a new cleaning crew that uses different cleaning chemicals? Has there been a recent change in the heating or air conditioning system?
#8 – What is the employee’s overall health condition?
An employee in poor overall health is a factor for concern.
#9 – Is there an ongoing claim?
#10 – Are there witnesses to confirm the employee’s symptoms are from an outside source?
Conclusion
By conducting a thorough investigation that includes identifying any potential underlying or root causes of a disease, you can clearly outline the compensability of an occupational claim. The practice of developing key factors when analyzing the information and records gathered will help you zero in on any potential causes of a disease.
Having access to the claimant’s complete medical history is significant since an occupational disease is contracted over a period of time.
If you are interested in learning more about our Workers' Compensation services, click on the link below to learn more.
