Problem
An individual was a restrained driver who was involved in a motor vehicle accident (MVA) and rear-ended. There was no airbag deployment. The speed at which the vehicles were traveling was not identified; however, it was noted that the posted speed limit was 60 mph.
Diagnosis
Diagnoses included post-traumatic headache, disorder of ligament, acute cystitis with hematuria, sprain of unspecified site of right knee, vertebrae, panniculitis, cervical radiculopathy, cervical sprain, lumbar sprain and rotator cuff sprain.
Solution
A Legal/Liability Nurse Review as requested to review medical records provided with comments/ synopsis of the medical condition, the relationship of complaints to injury of record, the existence of pre-existing conditions and the appropriateness of medical treatment.
Outcome
After review of all available medical records, the following diagnoses and treatment were found not casually related to the MVA: acute cystitis with hematuria and sprain of unspecified site of right knee. In addition, a number of treatments that were above usual and customary guidelines and therefore recommended as disallowed.
