502.495.5040

Presumption Peculiarities

Mar
08

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In many jurisdictions, first responders have the benefit of “presumption” (and rightfully so) when it comes to heart disease, cancers, respiratory injuries, etc. In layman’s terms, the workers’ comp carrier pays unless contrary competent evidence is available to rebut the claim. Who can argue with this?

 

First responders are under tremendous physical and mental stress, and they are exposed to all sorts of hazards during the course and scope of their employment. However, this doesn’t always mean that the comp payor has to roll over and blindly accept the plaintiff’s assertions.

 

We recently reviewed a claim on a young male first responder who was totally disabled from a rare form of cancer. Literally, this could be a million dollar claim. The medical record was thousands of pages, and the proposed treatment protocols were complex and expensive. There was no question this young man was totally disabled and deserved appropriate medical care.

 

Our physician reviewers determined this cancer is caused only by repeated exposure to a certain radioactive isotope. Fortunately, this employer maintains meticulous records as to every emergency call the responder made – including a detailed list of all hazardous materials encountered.

 

After a formal information request, we were able to document every run this injured worker made for his employer. The radioactive materials were never present.

 

We don’t know how this claim will be resolved, but the science tells us the cancer was not work related. Our thoughts go out to this young man during his journey back to health.

 

The question is, who should pay?
Call us. We can do better.

 

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

Posted in Medical Cost Containment, OMCA, Workers’ Compensation