Causation

Our Causation specialists are the post-injury fact finders who use occupational and non-occupational risk factors to help medical providers determine whether an injury is work related. We’re one of few workers’ compensation carriers who do this work – and it means $21M in loss avoidance on average each year.*

What is Causation?

Think about damage assessments done in other lines of insurance, like an investigator who assesses property after a house fire. Our causation efforts work in a similar way for workers’ compensation losses.

The AF Group causation process:

  • Observes an injured worker conducting their job duties to obtain objective information associated with a specific injury type (occupational and non-occupational risk factors) using American Medical Association (AMA) guidelines.
  • Is a referral-based program (e.g., initiated by a claim rep or policyholder who notices a red flag) in which the claim rep determines whether to pursue the effort. Causation is pursued on several types of claims:
    • Ergonomic
    • Subrogation
    • Large loss/lower extremity
    • Environmental disease
    • Return to work
  • Equips the claim rep with findings for the treating physician (i.e., independent medical exam (IME), qualified medical examiner (QME) or many other types of medical providers) – who ultimately concludes whether the injury is work related.
  • Is not loss control or fraud work – it doesn’t prevent injuries or work to convict fraud.

We do it Differently

  • The few carriers who dabble in causation use departmentalized written job descriptions to assess causation, while we investigate at an individual level using personal risk factors and video.
  • While other carriers just pay the low-hanging fruit (like carpal tunnel claims), we have found these to be the most common post-causation claim denials – and it saves! In some states, a carpal tunnel claim can cost up to $100K.
  • We have an expansive presence across the country that allows us to conduct onsite assessments and offer virtual video analysis.
  • Our Causation services are available to all policyholders as a free service – they’re never charged to the file.

Our Team

With more than 60 years of combined career experience, our staff includes a Doctor of Chiropractic Medicine, Masters in Public Health, Certified Professional Ergonomist, Certified Safe Patient Handling Associate and Certified Safety Professionals.

*AF Group Causation helped customers across all AF Group Workers’ Compensation Division brands avoided an average of $21M in losses between 2018 and 2021. Figures determined based on internal calculations combining average cost of injury by state.