CLAIM ISSUES:

• Multiple claims, or a history of frequent claims, or ongoing treatment of pre-existing conditions

• Multiple body parts or injuries are involved

• For determination of MMI from objective medical findings, of if treatment extends beyond a determination of MMI

• To determine causation

• Claim is lacking a correlation between symptoms and objective findings

• Evidence of early risk factors for delayed recovery

CLAIMANT ISSUES:

• Refusal to undergo reasonable diagnostic testing, or evidence of excessive testing

• Non-compliance

• Facilitate return to work, or if return to work has failed

• The claimant is not properly informed about their treatment options and lacks education to make informed choices

TREATMENT ISSUES:

• Inconsistent treating care, switching physicians, or unexplained gaps in care

• The current medical diagnosis is undetermined

• Absence of, or slower than expected, functional improvement

• To obtain a second opinion

• Medication concerns, particularly regarding the overuse of opioids

• Concern that treatment is not evidence-based

• Infrequent follow up

• Lack of attempts at the least invasive treatments before implementing active interventions

ENVIRONMENTAL CONCERNS:

• Continued exposure to potentially dangerous chemicals or allergens

• Chemical or environmental exposure with continued symptoms or complaints

• Chemical or environmental exposure with alternative medicine treatment approach

GENERAL GUIDELINE COMPLIANCE:

• Treatment plan is inconsistent with the generally accepted treatment guidelines

• Lack of functional progress despite medically appropriate treatment that is consistent with the MT U& T Guidelines

• Concerns about a treatment plan, or treatment that includes unusual methods

When in doubt – call and have a chat! 406-549-6520

*How geeky are you? We’re pretty serious about our treatment guidelines around here, Montana U & T Guidelines.

More good reading:
Genex Services. 2019. Seeing Red Warning signs of off track claims