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 can mean between $13-25M in loss avoidance in a single 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.  

Causation is pursued on several types of claims: 

  • Ergonomic 
  • Subrogation 
  • Large loss/lower extremity 
  • Environmental disease 
  • Return to work 

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. 
  • 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. 

AF Group Causation helped customers across the AF Group Workers’ Compensation
Division avoid an estimated $18 million in losses between 2018 and 2020. Figures
dependent on circumstances unique to each claim. Results may not be typical.

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