Workmen Comp medical records review is a crucial process that involves examining and analyzing medical documentation related to an individual's work-related injury or illness. The purpose of this review is to assess the appropriateness of the medical treatment provided, determine the extent of the injury or illness, and evaluate the overall claim for compensation.

Team Fortuna takes extreme care in Workmen Comp cases by following each and every required step to perfection
 

1.     Patient Information:

The Reviewer begins the review by gathering relevant details about the patient, including their name, age, occupation, and contact information. This information helps establish the individual's identity and provides context for their work-related injury or illness.

2.     Incident Details:

We document the specific details of the incident that led to the work-related injury or illness. This may include information such as the date, time, and location of the incident, as well as any relevant witnesses or reports filed.

3.     Medical History:
We review the patient's medical history to gain insights into any pre-existing conditions or previous injuries that may have an impact on the current claim. Paying attention to any relevant details, such as chronic illnesses, previous surgeries, or previous workers' compensation claims.

4.     Initial Assessment and Treatment:
We evaluate the initial assessment and treatment provided to the patient immediately after the work-related incident. This may involve reviewing emergency room records, first responder reports, or any other medical documentation from the initial stages of care.

5.     Diagnostic Tests:

We analyze the results of any diagnostic tests conducted to evaluate the extent of the injury or illness. This may include X-rays, MRIs, blood tests, or any other relevant diagnostic procedures. Assess the appropriateness of these tests in relation to the patient's condition.

6.     Treatment Plan and Progress Notes:
We review the treatment plan outlined by the healthcare provider and track the patient's progress through progress notes. Evaluate the consistency of the treatment plan with the diagnosed injury or illness and assess whether it aligns with established medical protocols.

7.     Specialist Consultations:
If the patient was referred to any specialists for further evaluation or treatment, we review the specialist consultation reports. We assess the specialist's recommendations and determine if they are consistent with the patient's condition and the overall treatment plan.

8.     Medication and Therapy:
We analyze the medications prescribed to the patient, including dosage and duration. Evaluate the appropriateness of the prescribed medications and assess the patient's response to the treatment. Additionally, we review any physical therapy or rehabilitation records to determine if the prescribed therapies align with the patient's condition.

9.     Functional Capacity Evaluation (FCE):
If an FCE was conducted, we review the results and assess the patient's functional abilities in relation to their work requirements. This evaluation helps determine the patient's capacity to return to work and the need for any work restrictions or accommodations.

10. Medical Opinions:
We pay attention to any medical opinions provided by the treating physicians, specialists, or independent medical examiners. We evaluate the objectivity and credibility of these opinions and consider how they align with the patient's medical records and the overall claim.

11. Compliance with Guidelines:
We assess whether the medical treatment provided complies with the relevant guidelines and regulations for work-related injuries or illnesses. This may include guidelines from the Occupational Safety and Health Administration (OSHA) or state-specific regulations.

12. Summary and Recommendations:
We summarize the findings of the medical records review, including the diagnosis, treatment provided, and progress of the patient. Based on the analysis, provide recommendations regarding the appropriateness of the treatment, the patient's functional capacity, and any further medical interventions required.

 

We at Fortuna understand the specific content and depth of the medical records, review may vary depending on the complexity of the case and the requirements of the workers' compensation system based on client’s jurisdiction. We adhere to the relevant legal and regulatory guidelines while conducting the records review.

 

After the final summary and review, a stringent quality check is performed to ensure that the resultant summary and review is matching Fortuna’s quality promise.