An ACM senior adjuster received a head and neck injury worker’s compensation claim. The employee, who had only worked for the company for five days, reportedly passed out and fell at work. He claimed headaches, sleep problems and depression were a result of the fall. He denied priors, but the Insurance Services Office showed a 2021 auto accident. The claimant testified he was not injured in that accident. A year into the auto accident claim, the Qualified Medical Evaluator said the claimant did not yet show Maximum Medical Improvement.
The adjuster found records showing prior complaints of headaches, sleep problems and depression. She referred the case to the Special Investigations Unit. We learned that the claimant was also seeing a chiropractor for neck injuries from the 2021 auto accident. With records served on the Applicant Attorney, the adjuster was able to settle the claim by Compromise and Release, without further litigation or QME expense.