A body that has been subjected to trauma may undergo
significant change. There are two basic types of changes that
can occur—structural change and functional change. Structural
change refers to visible differences in the body following the
traumatic injury. These can be visible to the naked eye, through
use of X-rays or microscopic analysis, or as a result of lab
tests. Fractures, amputations, and tumors would all be
considered structural changes.
Functional changes refer to disease processes that alter how
the body functions but do not change the structure of the body.
Because of advances made in psychosomatic medicine, it is
becoming increasingly clear that bodily functions can be
disturbed beyond what would have been expected from the
structural damage. Accidental injuries often include some
element of fright or fear. Emotional feelings can impact the
healing process so it is important for the claims professional
to understand the impact of emotions such as fear, anger, or
extreme worry and how they may extend the healing period.
Functional changes can cause structural failures, such as
ulcers, vascular failure, and heart conditions. Without
knowledge and understanding of these influencers, claims
professionals may find it difficult to accept or comprehend the
difficulties a claimant may experience if fright or worry
following a traumatic injury exacerbates a preexisting heart
condition or a neurosis or psychosis. These complications may
also cause the treating physician to be reluctant in quantifying
the healing period or even the extent of the disability.
Structural changes are relatively easy to diagnose and treat.
However, the impact of functional changes or conditions may
cause a physician to qualify the patient's prognosis, which in
turn may make it more difficult for the claims professional to
accurately assess the extent of the healing period as well as
the anticipated disability that is related to the accidental
injury.
What Are Traumatic Injuries?
Traumatic injuries are wounds or disabilities caused by an
external force. By contrast, congenital disorders, sometimes
called congenital diseases, are maladies that exist at birth or
before birth or may become apparent in the early days of
childhood. Some congenital conditions become apparent following
a disease or illness as a result of an infection.
Trauma can weaken the body and make it more susceptible to
infections, which in turn, may aggravate a congenital condition.
Claims professionals will want to consider this possibility when
evaluating bodily injury claims with the traumatic injury being
the catalyst for additional complications. So, while the primary
injury may have been caused by the trauma, comorbidities will
have significant impact on the length of disability, treatment
plan, prognosis, and permanent disability, if any.
To adequately assess traumatic injury, the claims
professional will want to obtain the following information from
either the injured party or the treating physician (after
execution of a medical authorization form by the patient).
The injury:
Initial medical care:
Ongoing medical treatment:
- Identification of treating physician
-
History of treating this
person
- Identification of all assisting or referring
physicians
-
Names and addresses, extent and
purpose of treatment given
- Dates of treatment, by whom, and for what
purpose
- If hospitalized, dates of inpatient service
and any outpatient follow-up
-
Operations or casts—including
treatment, dates of service
Recovery:
Medical history:
- Identification of prior medical conditions,
illnesses
- Treatment obtained in the past
- Ongoing care and why necessary
- Identification of all treating physicians
and facilities such as hospitals, clinics
- Preexisting disability
- Family history of illnesses, diseases, or
medical conditions
By obtaining complete information regarding the traumatic
injury itself and treatment of the injury, the claims
professional will begin to develop insight as to the extent of
the direct care needed for the accidental injury. Other
information, such as treatment plans and prognosis, will assist
in evaluating the extent of the healing period. Family history
is included in the investigation in order to determine whether
there is a propensity for preexisting conditions that may not
have been diagnosed in the patient yet but that may have a
bearing on the prognosis and eventual recovery.
Conclusion
By gaining an understanding of psychosomatic medicine and the
impact of emotions and the environment on the healing process,
claims adjusters will be better prepared to evaluate traumatic
injuries.