Reference no: EM133193346 , Length: Word count: 2 Pages

Assignment Problem:

Carpenter Mike files a repetitive trauma claim for a shoulder injury. You are the Safety director at your company and you heard through the Grapevine that Mike is also the star pitcher for "the carpenters" softball team. What types of investigations might you do in house to assist your claims adjuster? Would or could this fall into an aggravation of a pre- existing condition? What factors might you look at before the decision is made to deny or accept this case as compensable?

POST 1:

First: I would conduct a full investigation that included Carpenter Mike's job description as well as any recent or new JSA's in relation to his work. I would conduct task observations that Mike would have normally performed that could give me further insights into Mike's claim. Also during my investigation, I would question some of Mike's co-workers to see if he had previously made any comments to his shoulder injury and if they in fact arouse from and in the course of employment. During my investigations, I would be documenting the facts and creating a chronological order of events that lead to the claim. I would also reach out to Mike to attempt to determine a time and place of the injury while also asking questions about both work tasks he was performing and questions about him playing softball. I would attempt to reach out to some of his teammates and inquire on information such as last game played, positions Mike played, and if anything happened that may have been a contributing factor to the injury. I would then check Mike's personnel file for any past incidents reports that may have included a shoulder injury and what treatment he received if applicable. I would within my legal abilities try an obtain medical records past and present in attempt to determine if this was a pre-existing condition. Most likely I think Mike would have to request that information to turn in because of HIPPA laws and without a subpoena. In conclusion, I would exhaust all efforts to better determine if this was in fact a work-related case. Depending on the investigation findings this case could be an aggravation of an pre-existing injury. Compensation for these claims can be very tricky and difficult. If there was a pre-existing condition, this would be discovered when medical records or internal records are obtained and reviewed. To my knowledge, if the shoulder injury was personal in nature and determined through records to not be work related it would not be compensable. Many of the factors I would consider in accepting or denying this case was given in my first paragraph. But in short, I would consider what Mike was doing at the time of the alleged injury as well as prior to and if he had mentioned anything to any of his co-workers. Another thing I would factor is any past incidents reported by Mike at our company as well as his play in softball.

POST 2:

Second: The first place to start would be to determine the facts.  Facts would be gathered by conducting interviews (both with Mike and with co-workers who function in a similar role), reviewing job functions and job descriptions. Some interview questions I would ask of Mike would be when he first noticed pain, what he was doing when he started to feel the pain, any remedies that he sought out after noticing the pain.  As part of interviewing Mike's co workers I would try to determine whether there was an acute event or if the injury could be the result of chronic use. By reviewing the job description I would hope to gather a good indication of the various job responsibilities and how they would translate to a potential industry.  I would apply a similar action to interviewing other member's of the softball team, minus looking at a job description.  I would interview Mike and ask him if he experienced any acute pain while pitching for the softball team, and likewise ask the other members of the softball team if they noticed anything that would indicate Mike had an injury (if they were willing to discuss it).Repetitive trauma cases are difficult to say the least.  Given the outside activity (softball pitching) and the job itself (carpenter) there is certainly room to argue that this would be both aggravation of a pre-existing condition and also an injury that "arose out of" and "in the course of" employment.  Establishing the time line of reports of injury and medical evaluations can go along way in determining if the injury came from an acute event or from chronic use.