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Medical Review

Medical legal cases often require medical review and unbiased opinions from a doctor who is not associated with an insurer, injured party or negligent party. A second opinion can weed out fraudulent claims, spot treatment errors and helps ensures that an injured party receives the care that they need to recover from his or her injury as quickly as possible.

Prevents Cutting Corners in Patient Care

Insurance companies are not in the business to lose money. Their goal is to make money for their shareholders. When managing the care of claimants in workers’ compensation or other personal injury cases, there always exists the possibility that corners could be cut in patient care. Insurance doctors may avoid recommending expensive diagnostic tests or treatments that patients need. This could be to keep expenses down for the insurer or ensure that they will continue to receive referrals from the insurer.

This practice hurts not only the injured party, but also the employer or negligent party. Improper or unneeded treatment can prolong the time out of work and extend the length of time that the injured party is under medical care. With workers’ compensation cases, the employer is also entitled to request an independent medical examination (IME) if he or she has concerns regarding extensive medical treatment, including surgery or other long-term treatment.

When a Second Opinion is Needed

A medical review and unbiased opinion from a second physician is advisable and/or required in legal cases that involve claims for:

  • Workers’ compensation
  • Insurance claims for accidental injuries (e.g. motor vehicle, slip and fall, falling objects)
  • Medical malpractice
  • Medical negligence
  • Wrongful death

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The Occupational Safety and Health Act was signed into law by President Richard Nixon on December 29, 1970. The purpose of this Act was to ensure worker and workplace safety by requiring employers to provide workplaces that are free from known safety and health hazards, including:

  • Exposure to toxic chemicals
  • Mechanical dangers
  • Unsanitary conditions
  • Excessive levels of noise
  • Heat or cold stress

To establish workplace health and safety standards, the Act created the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH). Additionally, the Act created the independent agency of Occupational Safety and Health Review Commission (OSHRC).

Responsibilities of OSHA, NIOSH and OSHRC

OSHA’s purpose is to create, administer and enforce compliance of workplace standards in all 50 states. As a part of the U.S. Department of Labor, OSHA also provides employers with additional standards that they must comply with above the General Duty Clause of the Act that requires employers to keep their workplace free of serious recognized hazards.

NIOSH’s purpose is to conduct research and make recommendations to prevent work-related injuries and illnesses. This agency is a division of the Centers for Disease Control and Prevention (CDC), which is under the auspices of the U.S. Department of Health and Human Services.

OSHRC’s purpose is to decide contests of citations or penalties for workplaces that have been assessed for violations found during an OSHA inspection. This Review Commission provides a two-tiered administrative court that:

  • Conducts hearings, receives evidence and renders decisions made by its Administrative Law Judges (ALJs)
  • Provides a discretionary review of decisions made by the ALJs with its panel of Commissioners

Employers are required to report workplace injuries and illnesses to OSHA. The OSH Act continues to work toward improving the health and safety of employees since its inception.

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Dr. Anjmun Sharma

A Medical Review Officer is a fully licensed physician who works in the laboratory to ensure that data and results collected by the drug screen are examined and addressed. They play an imperative role in the drug screening process for both the employee and the employer. Some of the roles are described below.

He or she helps to interpret and review the laboratory results. This consequently protects the employers from making decisions regarding the employee’s claims that his or her drug test results were caused by medical treatment or medication. It also keeps the employer from dealing with complicated matters related to the disclosure or the release of private medical information pertaining the employee.

The Medical Review Officer reviews the results from the lab to ensure that the correct test was undertaken and the right procedures followed. If a drug test is positive, it is his or her responsibility to contact the employee to explain the validity of the outcome. Results are reported to the employer in cases where the employee fails to provide feedback. Additional information concerning the laboratory and federal agency is also shared with the employer.

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Identify Injury

Lacerations are continually ranked as one of the most common workplace injuries, approximately 30 percent of all accidents involve lacerations or cuts.

Although injuries can happen anywhere, cuts and lacerations are frequently the result of workplace accidents. Typical causes of these injuries in the workplace include lack of established safety procedures, improper training, poor lighting, employees rushing or taking shortcuts, and missing or improper use of safety equipment.


A bleeding wound is generally one of four varieties: abrasions, cuts, avulsions, and lacerations. Abrasions are minor wounds that are caused by friction often missing skin and minimal bleeding. Avulsions are generally more serious where the tissue is torn and separated from the body. Cuts are often caused by sharp objects with separation of the tissue/skin. Lacerations are also caused by sharp objects leaving the skin torn in a jagged nature and are often mistaken for cuts. Cuts and lacerations are the most common types of injury that occur in the workplace.


It is important to be able to identify a laceration versus a cut. If an injury occurs in the workplace, it is critical to know when to properly seek medical attention in case stitches or surgery is required. Where cuts tend to be superficial, affecting only the surface of the skin, lacerations are significantly deeper, often damaging nerves, ligaments, muscles, tendons and sometimes bones.  


As an employer, being able to identify how an employee has sustained an injury is important to immediately treat the wound. General first-aid procedures prescribe to seek medical help immediately if the bleeding does not stop after 10-15-minutes. Many industries mandate companies provide first-aid classes, but if this is not the norm for your company then consider one in order to empower your employees and increase workplace safety. The application and necessity of first-aid demonstrate the importance to understanding how to identify a cut or laceration and how to treat the injury.


Should an employee require further medical assistance an excellent alternative to urgent care centers and emergency rooms are walk-in clinics. Most walk-in clinics are staffed by physician assistants or nurse practitioners. These clinics are typically set up inside or adjacent to a large retailer or pharmacy for maximum patient convenience. Longer hours are offered and most are open every day of the week to accommodate patients when their private doctor’s office is closed or when they cannot wait for the next available appointment. Clinical services are also less expensive than a visit to an urgent care center or emergency room and take most private insurances to include Medicare, and Medicaid. Transparency in pricing is one way in which retail clinics reflect growing trends in health care. Many people are buying insurance with higher deductibles as they are looking for those alternatives to hospital or physician’s office visits that are going to be more cost-effective and convenient.


Our clinic provides Monument, and the Northern Colorado Springs area, with physician services without having an appointment. You will be able to skip the wait at our clinic and receive the best possible medical care at your convenience. We are able to meet the health and wellness needs for individuals of all ages. Walk-in clinics offer a variety of other services and treatments such as non-life-threatening common ill­nesses, bronchitis, tetanus, pinkeye and styes, sinus infections, vaccinations for flu, physical exams, and other minor injuries.


Article by Talk Out Loud


A decision was made on March 1st, allowing an OSHA rule to be overturned. The Volks rule entailed that employers must keep injury and illness-related work records for a period of five years. However, some felt that this rule did nothing to improve safety and was intrusive. H.J. Res 83, the name of this resolution, was approved by a vote of 231-191.

Those who voted for the resolution to be passed were vocal about their discontent with the Volks rule. Bradley Bryne, a republican chairman, accused OSHA of making a “power grab” and would go on to state that the Volks Rule “does nothing to improve workplace safety.” However, there are still steps that must be completed for this resolution to become fully official.

Currently, the resolution will now be presented to the Senate for an official action to be made. Should the resolution continue to gain momentum, there is the possibility that it could become officially adopted. However, this resolution would still need to be signed off on by President Trump.

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OSHA or the Occupational Safety and Health Administration was created by Congress in 1970. Since its creation, OSHA has been making workplaces safer for over four decades. Extremely minor workplace injuries that don’t require first aid are not usually deemed to be a recordable injury. An injury that impairs the employee’s ability to effectively perform their job is deemed recordable. In addition, an injury that causes damaged bones, punctured eardrums, irreversible disease, or fatality are all examples of recordable injuries.

Records aren’t only in place to help injured employees, this data is reported to OSHA for purpose of keeping records of business statistics. There are different rules regarding time frames of reporting certain injuries. For example, an employer must report a fatality involving a worker within eight hours. However, if the incident only involved loss of limb, the employer has 24 hours to report the incident.

OSHA continues to monitor how businesses prevent workplace injuries and deaths from occurring. Ensuring injury reports are kept up to date and accurate must be of the utmost importance for any business owner.

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Drug Testing

Pre-employment and randomized drug testing can safeguard your company from the risks associated with workplace accidents.

Injuries and high turnover rates are some of the problems that companies face when substance abuse becomes an issue. The quality of hire in your staffing efforts increases when you have employees who are drug-free. You can trust your employees to focus on the critical details in ensuring job safety.

Drug and alcohol screening has become a common measure in today’s business industry. Resumes rarely tell the whole story of a prospective employee’s past. Nearly 67% of job resumes and job applications of unscreened employees contain falsifications. Substance screening during the hiring process will protect your business and reduce the harmful effects of drug and alcohol abuse. Accidents, tardiness, high turnover rates, temperament problems, embezzlement, low productivity and morale, crime, and violence are to name only a few of the issues associated with substance abuse. You know your staff is less likely to become a legal liability when they are drug-free.

Legal recreational use of marijuana in Colorado does not affect your company’s drug use policies. You have a choice to mandate pre-employment drug testing, alcohol testing, and institute randomized testing for hirees. It does not affect the Colorado Law of 1991 that requires testing for federally-regulated employers and anyone who has a job concerning public safety while operating sensitive transportation vehicles, such as trains, buses, planes, trucks, etc. Schools, hospitals, and some organizations that implement drug testing programs qualify for legal incentives. One example of these incentives is reduced costs for workers’ compensation and insurance. All employers should consult with their legal advisor to ensure compliance with applicable state or local drug testing laws in order to create drug testing policies and procedures in accordance with these regulations.

Federally-regulated employers only collect urine samples for testing, however, the Secretary of Health and Human Services has proposed revisions to include oral fluid specimens. Drug tests can vary depending on the type of test the employer chooses to mandate. Urine, saliva, sweat, or hair can be used as test specimens. Testing can screen for marijuana, opioids, amphetamines, phencyclidine (PCP), and cocaine usage. A drug-free workplace can require testing based on the following: Post-accident testing, pre-employment testing, return-to-duty testing, random testing, follow-up testing and reasonable cause or suspicion testing.

Employers can save the company money by preventing accidents caused by impaired workers with preventative measures such as mandatory and randomized testing. Testing imbues an anti-substance abuse culture in the workplace that can save money on workers compensation premiums. The National Safety Council and national nonprofit Shatterproof have collaborated with an independent research institution, NORC at the University of Chicago to design “The Real Cost of Substance Use to Employers”. To estimate the cost of substance abuse by the industry you can use the calculator tool that provides business leaders with specific information about the cost of substance use.

For more information about creating and implementing a prevention and treatment program for your employees, contact the Drug-Free Workplace Helpline at 1-800-WORKPLACE (1-800-967-5752), coordinated by the Substance Abuse and Mental Health Services Administration (SAMHSA).The Substance Abuse and Mental Health Services Administration (SAMSHA) is a federal agency that works to reduce the impact of substance abuse in the United States and is part of the Department of Health and Human Services.

Article by Talk Out Loud

Workers' Compensation

Fraudulent workers’ compensation claims occur when a worker has falsified an injury. Most often, these false claims are done strictly to get compensation from an employer. An employee can also work somewhere else while already drawing workers’ compensation from another business.

Keeping in constant contact with the injured party is highly recommended throughout the duration of their claim. In addition, learning what behaviors are consistent with false workers’ compensation can save a business large sums of money.
There are methods that can help spot a fraudulent claim. A lack of witnesses is a potential sign that workers’ compensation fraud is occurring. Another behavior that could entail potential fraud is if the injured party keeps changing their story or gives differing details. After a workplace injury has occurred, medical treatment will likely follow. However, if the injured party shows any reluctance or refuses treatment, this is a telltale sign of workers’ compensation fraud.

Fraudulent workplace injury claims are estimated to cost businesses about $5 billion each year. It’s important to learn what signs of a false workplace claim are to avoid being a business paying out part of that yearly $5 billion.

Article by AllRevedUp Internet Solutions powered by WSI.

Here at Monument Occupational Medicine, we’re committed to provide you with all the latest information from within the occupational health services industry. We work with our partners throughout the occupational health sector to ensure our patients and clients remain informed.

Our team researches the market regularly in order to deliver news on regulatory changes and interesting stories regarding the changes taking place. This ensures you’re always informed and able to make the right choice on your occupational health service needs. If you have any questions about the latest changes within the occupational health services market, call our team now at 719-445-9852

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