1.      What is a Soft-tissue Injury?

2.      Why only soft-tissue injury claims?

3.      What is a "ClaimAlert^® Profile"?

4.      What is the turn-around time for the Profile?

5.      What difference does it make if you use Objective or Subjective information?

6.      Do you need the entire file?

7.      What were your results of your beta-testing?

8.      Do you Profile only Workers' Comp or Personal Injury Claims?

9.      How would your services assist Union Organizations?

10.  How is this possible to benefit both the Employer and the Union?

11.  Why use Range of Motion [ROM] Findings as your objective data standard?

12.  Can your reports also calculate the Disability Ratings Percentage based on the AMA 5th Edition Standards?

13.  Do you use the pain scale scores as an objective measure in your report?

 Q:  What is a Soft-tissue Injury?

  A:  Damage to tissue that encloses bones or joints, such as muscles, tendons, or ligaments.

Q:  Why only soft-tissue injury claims?

 A:  Soft-tissue injuries are the only injuries that can be measured OBJECTIVLY.

Q:  What is a "ClaimAlert^® Profile"?

 A: A ClaimAlert^® Profile is:

1.    A graphic profile tool of all the objective findings found in a claim file.

 2.   A body of objective evidence useful to validate behaviors or providers and claimants.

 And much more.......

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Q:  What is the turn-around time for the Profile?

 A:  From the time we receive the claim file electronically, you will receive the finished tool within 72 hours.

 Q:  What difference does it make if you use Objective or Subjective information?

 A:  Subjective information is arguable and Objective data is evidence.

 The following are common findings than could be found in a soft-tissue injury file:

1.      "His elbow injury is getting better." 

·          This is a subjective opinion/statement. 

·          Better than What?

·          Better than When?

2.     Doctor 'A' might differ with that opinion and say "His elbow is getting somewhat better."

3.     Subjective information leads to confrontation because everyone is entitled to their own opinion.

Now this:

1.  "The Right Elbow Extension is 10 degrees, as opposed to 15 degrees measured 3 weeks ago."

·         This is an Objective finding. 

·         Measurements are Objective information. 

·         Is the claimant getting better or getting worse? In this case worse.

·         Further treatment appears to be justified.

2.      Doctor A will have the same measurement as Doctor B because the method for obtaining the information is standardized.

3.      Objective information is measurable and non-confrontational.

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Q:  Do you need the entire file?

            A:  We need to profile the same file documents that will be used in the event of litigation or regulatory review.   

Q:  What were your results of your beta-testing?

            A: A Pilot Project was conducted from October 2003 – May 2004 in Honolulu, Hawaii. 

1.      33 Soft-tissue injury cases were process with the proprietary application. over a

• Case Age Statistics: Years Open
  • Average = 7.9 yrs
  • Median = 4.5 yrs
  • Mean = 5.9 yrs
  • Range: = 1.8 yrs to  36.7 yrs
• An initial ClaimAlert^® Profile was performed on all 33 cases.
• Outcomes after the Initial ClaimAlert^® Profile,
  • HIGA: Took immediate action on all 33 cases based on the profile data.
  • Cases Closed – Settled [No Appeals]: 10 Cases [30%] :
    • Resolved Medicals [No Appeals]: 13 Cases [40%] :
    • Scheduled for follow-up ClaimAlert^® Profile: 10 Cases [30.%]
• Outcomes after the follow-up ClaimAlert^® Profile [10 Cases]

• 3 cases [09.1%]: Treating Physician agrees to reduce the intensity of treatment.
• 2 Cases [06.1%]: Denied future medical treatment - Did not Appeal
• 3 Cases [09.1%]: All Future Medical Benefits Denied – Did Not Appeal
• 2 Cases [06.1%]: All treatment reasonable, appropriate and necessary – no change in status at end of project. Post Beta-Test
• Summary:
  • Treatment Continued: 2 Cases [6.1%]
  • Treatment Frequency Reduced: 4 Cases [12.1%]
  • Future Medicals Denied: 8 Cases [24.2%]
  • Future Passive Treatment Denied: 9 Cases [27.3]
  • All cases resolved without an appeal by providers or claimant’s attorneys.
  • ROI 470%

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Q:  Do you Profile only Workers' Comp or Personal Injury Claims?

            A:  No, we also maintain pre-employment post-offer and Aging Workforce range of motion data to compare and contrast changes after a work injury to insure, in the event of a work related soft-tissue injury, the employer’s responsibilities for the worker’s claims for damages are mitigated by pre-existing conditions. 

Q:  How would your services assist Union Organizations?

1.      Actually, our services are especially valuable to a Union Organization concerned that their members are receiving their full value recovery benefits.

2.      When a member is returned to work, the dues are now being paid into the union. 

 Q:  How is this possible to benefit both the Employer and Union?

 A:  When an employee is injured at work, the duty of the company is to restore the injured person to the same condition they were just prior to the injury as if the injury never occurred.  With our services, the employer and the Union would know the level or degree of recovery that is owed as a result of the work injury.  The  does not discriminate, is non-biased and works for the benefit of both parties by providing an objective level playing field from which to set a baseline ROM Findings.  Data is data, good, bad or indifferent. 

 Suppose the initial findings of a worker were found to be sub-normal at the beginning of their employment.  If the conditions did not limit their ability for the job description, then the sub-normal findings are not an issue.  Now 15 years later, the worker injures an area that was sub-normal initially, does the employer owe to return the worker to 100% condition or the documented condition?  With both sides aware of their rights and responsibilities right from the start, then the need to litigate for unwarranted claims is no longer an issue.

 We suspect that many soft-tissue injury work comp cases that are the most difficult to manage may be due to this phenomena.  Until Claim Check, there was no way of documenting this information.  Now an employer or union organization can initiate a Work Force program to periodically monitor the baseline changes in their workforce as another level of assurance against unreasonable claims by either party. The ClaimAlert(R) Profile acts as an objective referee.

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 Q:  Why use Range of Motion [ROM] Findings as your objective data standard?

A:  A variety of reasons.

1.      Medical providers are required by payors to submit measured range-of-motion findings at every office visit as an objective measurement of the efficacy of their treatment plan before they are paid for services.

·          This is a reasonable and necessary demand in as much as the payor is paying for the services and should have the opportunity to assess the level of care at the minimum of costs.

·          The objective findings provide the documented evidence of recovery and efficacy of treatment.

·          A finding of “Getting better” is not a standardized measurement.

·          The majority of the medical treatment providers use the American Medical Association Range of Motion Standard degree measurements from normal to substantiate services and measure the efficacy of their treatment plan.

·          In addition, the AMA Standard is the legally accepted standard. 

2.   In the event a soft-tissue case cannot be settled or arbitrated successfully, it is usually because the SUBJECTIVE medical opinions are in such conflict that a fair and impartial ruling cannot be easily and objectively resolved between the parties.

·          The next level of resolution, when all else fails, is usually decided by the 12 people that will sit on a jury.

·          A competent attorney should be skilled enough to educate the entire jury of the value of the OBJECTIVE findings versus the conflicting SUBJECTIVE findings of multiple doctors to support their payors case. 

·          A consistent and documented “deficit” measurement of an injury motion as disclosed by a ClaimAlert(R) Profile would not be confused with a “Getting better” opinion and would more than likely carry greater credibility by the panel.

·          It is inconceivable that none of the 12 members of the panel has ever experienced a soft-tissue injury or ROM measurements in their lifetime. 

·          We feel a reasonable jury would return a decision in favor of an unbiased document based on the OBJECTIVE findings as opposed to Subjective opinions. 

·          We are confident that reasonable minds will prevail and that the case will be settled and never reach a jury once the ClaimAlert(R) Profile information is disclosed in discovery.1

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Q:  Can your reports also calculate the Disability Ratings Percentage based on the AMA 5th Edition Standards?

A:  No, and we have no plans to include that as part of future services.  We have been approved by the Work Loss Data Institute to have their Official Disability Guideline integrated into our application so our application will have even greater services and value in the future. 

 Q:  Do you use the pain scale scores as an objective measure in your report?

A:  No, we select only the Range of Motion Findings of the claimed injury.  Pain scales are SUBJECTIVE in nature and not an objective measurement.  One person's level 3 could be another person's level 14 on a scale of 1 to 10.