Non-Industrial Injury Claims
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Case Challenge #1
A claimant's extended absence from work didn't seem consistent with the relatively minor injury he had initially reported in his claim, which led us to believe that his injuries and illness might not have been entirely work-related.

Our Solution
An employee fainted at work, reported a "bump on the head" injury, and was taken to the emergency room. However, he did not return to work in a time commensurate with this sort of injury. Further investigation of the employee's medical record indicated a broken foot, which had occurred on a separate occasion, when he fainted in his home. When interviewed, the employee stated that he was diagnosed with low blood pressure, a side-effect (along with fainting) of a medication he was using for treatment of neuromuscular disorders. As this illness - and the foot injury it caused - was not work-related, the nurse case manager was able to close the case.