A Case Study in:
Susan's attorney contacted us after his services were retained following her involvement in a motor vehicle accident. Susan’s insurance carrier denied benefits after the accident citing pre-existing conditions as the reason for denial.
The attorney requested an evaluation by a case manager to evaluate the home environment and need for attendant care services from the family. As Susan needed some help before the accident, he asked for assistance in determining whether the level of care changed following the motor vehicle accident.
He requested an experienced case manager with knowledge of brain injury and an understanding of home care/attendant care to provide an assessment. He noted a written report was required and the case manager would need to be available to testify as an Expert Witness at trial.
Susan was diagnosed with bi-polar disorder at the age of 22. She sustained a mild head injury during a previous motor vehicle accident. Though she needed assistance while in the community, she took care of all of her activities of daily living independently. Susan’s family left her alone for 4-6 hours at a time. She could bathe herself and was not at risk for falls. Susan assisted with grocery shopping and simple meal preparation. She drove for short distances in her neighborhood. Following the second accident the family reported she is unable to perform any of these tasks.
- The case manager requested and reviewed all available medical records submitted by the attorney.
- As pre-accident records were unavailable, the case manager suggested the attorney secure records from the primary care physician and physical therapy provider who provided short term after the prior MVA.
- The case manager met with the client and all family members providing care. Susan and her family members were interviewed in order for the case manager to fully understand her pre and post-accident needs.
- The family provided information regarding the care they provided prior to the second accident and after. A full home assessment was completed.
The case manager established Susan was not safe to be left alone in the home without constant supervision and oversight. The case manager concluded the 24/7 supervision was critical for her safety. Susan was unaware of her environment and required assistance for all ADL’s. She was now walking with an unsteady gait and at risk for falls. Family members reported Susan would wander and she required monitoring to prevent her from leaving the house alone.
The case manager prepared a detailed report documenting Susan’s issues, safety needs, and the type of attendant care she required. After discussing our findings with the attorney a detailed report was submitted outlining our recommendations.
The case manager was called to testify. She was able to explain her findings from the thorough record review and home assessment. In combination with physician assessments, the attorney was easily able to establish the need for care and the impact the second accident had on Susan’s ability to function. A substantial settlement was obtained, which will cover Susan’s prior and future care for the rest of her life.