How Insufficient Evidence Can Hurt Your Disability / Worker’s Comp Claim in Florida

The Problems With Insufficient Evidence

Experiencing a physical injury can be a challenging process, in both dealing with the effects of the injury as well as the modifications to one’s lifestyle that are often necessary during the recovery process. An injury that restricts movement can be particularly debilitating, as it can interfere with, and, in some cases, prevent, the ability to work.

In situations where loss of income is an issue, a Workers’ Compensation or Disability Claim may come into play, it is important to understand what each one entails under specific Florida State Guidelines as well as what needs to be done to ensure a successful claim.

In terms of Workers’ Compensation, entitles you to certain indemnity benefits, which depend on the extent and nature of your injury, and are classified into the following categories:

  • Temporary Total Disability (TTD)
  • Temporary Partial Disability (TPD)
  • Permanent Partial Disability (PPD)
  • Permanent Total Disability (PTD)
  • Rehabilitation Temporary Total Disability

The initial determination as to the severity of the injury requires an “approved” physician chosen by the employer, a second opinion may be obtained by the physician of the patient’s choice, and both evaluations will be used when determining benefits.

In terms of disability, claims are determined by the Division of Disability Determinations (DDD), which operates under the Florida Department of Health. Unlike most states, Florida utilizes disability examiners, as opposed to medical professionals, to make medical assessments regarding the severity and limitations of the injury. It is important to note that only 26.8% of individuals are approved at the initial application stage in Florida which is lower than the national average disability approval rate of 31%.

The chief goal of the disability examiner is to obtain the information from the medical professionals providing treatment as listed on the disability application. This is the information that will be used to determine if the claim meets the SSA Guidelines of Disability.

What both Workers’ Compensation and Disability Claims in the state of Florida have in common is this: both processes will be approved based on the quality of information contained in the patient’s medical records. If records are based on medical opinion without the proper documentation to back up these opinions, then there is a very good chance that the claim will be denied. If this is the case, then a lengthy appeals process will ensue during which proving medical necessity will be crucial to ensure a positive outcome.

To secure a successful Workers’ Compensation/Disability Claim in the State of Florida, it is important to have as much documented evidence of medical necessity as possible during the initial medical examination. Medical records should contain enough detailed, objective information to support the claim as well as proof that the proposed treatment plan is reasonable and necessary.

Accurate Range of Motion and Muscle Testing is crucial to developing an effective treatment plan, however, due to the lack of clinical guidelines for manual testing, the results are often considered subjective and can often be the reason that a claim is delayed or denied. In short, objective medical findings combined with documented evidence are the key to a successful claim.

Kennebec is a leading provider of Muscle Testing and Range of Motion Testing products that are designed to meet the needs of the patient while providing the necessary documentation to support the rising demands of today’s healthcare industry. The easy-to-use integrated software modules document medical necessity as well as projected outcomes, with results that are consistent and reliable. P.R.O.O.F. Preferred’s Premium level includes three different narrative reports designed for documenting Personal Injury and Workers’ Compensation cases.

Proven to work in Independent Medical Exams (IME), Personal Injury and Workers’ Compensation cases, P.R.O.O.F. Preferred’s proven technology can provide the following:

  • Determine consistency of effort in FCE Exams and Workers’ Compensation cases
  • Establish baselines, document performance and progress
  • Provide objective and reliable results in the form of tangible and credible reports

For more information on how Kennebec’s products can help provide the necessary information to support a Workers’ Compensation or Disability claim, contact them today to request more information or to speak with their expert staff.