Injury Response & Reporting
How to Determine Workers’ Comp Injury Causation
Make fair, defensible calls on whether an injury is work related
Playbook content
Introduction
- PDFPlaybook outlineDownload · PDF
- Fundamentals of Workers' Comp Injury CausationVideo · 4:19
Section 1
- Aggravation vs. ExacerbationVideo · 13:42
- Two OJ Simpson Trial Outcomes to Understand CausationVideo · 7:38
- Protocol check 1Pass at 70%
Section 2
- 6 Step Process To Determine CausationVideo · 14:11
- Shoulder Injury Example, Review of Causation FactorsVideo · 6:52
- Protocol check 2Pass at 70%
Section 3
- Action Steps To Address Most Challenging Causation IssuesVideo · 18:49
- Steps to Execute a Thorough InvestigationVideo · 6:22
- Protocol check 3Pass at 70%
About this playbook
Whether a claim exists at all depends on whether the injury is work related. The medical and legal detail can be complex, but employers and claims handlers need a few key concepts to make fair, informed decisions. This playbook covers aggravation versus exacerbation, a six step causation process, a worked shoulder injury example, and the investigation steps for the hardest cases.
You will be able to
- Distinguish an aggravation from an exacerbation
- Apply the six step process to determine causation
- Spot the red flags that point to possible fraud
- Bring in medical expertise and evidence based medicine when needed
- Run a thorough investigation on the hardest causation cases