This document discusses strategies for handling complex workers' compensation exposure claims that involve multiple injuries, illnesses, physicians, employers or exposures. It outlines steps to take such as investigating prior medical and employment history, conducting an employer and exposure investigation, determining when to obtain an independent medical examination, evaluating the IME results, and deciding whether to accept or deny the claim. The document also covers considerations for vocational rehabilitation, claim closure outcomes, and provides final thoughts around thoroughly reviewing medical records and legal issues.

1. HANDLING COMPLEX EXPOSURES Panel Discussion Gary Keehn Michael Medrano

2. Complex Exposures? Multiple Claims/Injuries/Physicians Psyche Component Death Caused by Exposures Serious Illnesses Caused by Exposure Multiple Employers & Exposures Occupational Diseases

3. Exposure Claim Discovery Prior Medical History Prior Medical Records Personnel File Work History Occupational Exposures?? Daily Life Exposures?

4. Employer Investigation Employment Period Type of Employee Job Duties Job Locations Supervisors Co-employees Job Analysis MSDS

5. Injured Worker Statement When should you obtain? Prepare the Claimant Life, Education, & Employment History Employer Work History – Exposures & Protection Medical History – Pre & Post Claim Filing Insurance Claim History

6. Exposure Investigation Confirm Activities Confirm Exposures MSDS Environmental Studies Protective Equipment Documentation Revisit Records Obtained Supervisor & Co-employee Statements Subrogation?

7. Independent Medical Examination When is it time? Is an IME needed? What Type? What is the IME evaluating? How important is your IME letter? Review all medical records? JA Review? Diagnostic Testing?

8. IME Results Garbage in……

9. IME Results Garbage OUT!

10. And the Decision is……. Accepted Claim – Mitigation begins; Reserves, Medical Management, Excess Considerations. Denied Claim – Litigation begins in most cases. DLI Approves denial? Protest/Appeal? BIIA Involvement.

11. Voc Rehab Considerations Subsequent Injury Disability Convictions Extended TL Deterioration of health/condition Educational barriers Rx Abuse/Addiction Pension Expectation

12. Claim Closure Outcomes Second Injury Fund Straight Pension Widow’s Pension Third Party Litigation Claim Closure – Reopening Sidebar Settlements

13. Final Thoughts Medical Records Thorough Investigation Legal Review & Recommendations Educate the IME Do the Right Thing