08/03/2026
"It looked like a simple hammer injury..."
Until we reviewed the medical records.
The worker reported striking his left leg with a hammer on a Monday.
He didn't report the injury to his supervisor because he believed it would resolve on its own, and he continued working without missing any time.
By Thursday morning, his leg was reportedly throbbing, so he informed his supervisor of the incident and went to the emergency department.
At first glance, the claim appeared reasonable.
Then we reviewed the contemporaneous medical records.
Instead of documenting a recent hammer injury, the emergency physician recorded a two-month history of left leg and foot pain, worsening over the previous week.
The worker specifically denied any recent trauma or injury.
The examination identified varicose veins and a furuncle of the left shin. He was treated with antibiotics, returned to full duty the very next day, and finished the remainder of the workweek.
Later, he reportedly underwent additional treatment, possibly surgery, because of significant bleeding. Despite remaining in contact with his employer, he did not provide medical documentation supporting his ongoing absence from work.
After comparing the reported mechanism of injury with the contemporaneous medical records (none of which documented a surgery), our recommendation was straightforward:
Deny the claim.
Sometimes the greatest savings don't come from closing a claim.
They come from preventing a non-industrial condition from becoming an unnecessary workers' compensation expense.
Medical governance isn't about denying claims. It's about making sure the right claims are accepted and the wrong ones aren't.
