A “major contributing cause” is probably the best kept secret for the insurance company because it means that if the major contributing cause, the need of your care is something in your past, they don’t owe you anymore.
If you’ve got a prior auto accident, and you go to the doctor, and the doctor treats you, and then all the sudden, the nurse case manager/adjuster says, “Did you know he had a car accident back in 2002?”, and the doctor, “Do you think the main reason for the treatment is the old stuff?”, or this little trippy added work, they cut you off.
That’s the mechanism.
So what the main thing to do is to get to the doctor before they do and make sure that he’s filled out that the major contributing cause, the need for this treatment is this. And the way I do it is when I’m interviewing the client, “Let’s go over your past. Let’s take a medical authorization. Go get those records.”
It’s usually something easy like “Yeah, he had a prior back claim,” well, it was his neck, now it’s his low back. The insurance industry uses the term “back”.
So all the sudden, the doctor hears “back”, “Oh he’s had it before.” Maybe it’s the cervical neck region they’ve heard this time and not his low back lumbar. You’ve got to clean up the mechanism of injuries and where the accident is in order to present the claim, and then your checks start.
They’ll cut everything off if the major contributing cause is not lined up properly.
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