Don’t Just Know the Facts, Know What They Mean

A command of the facts is essential to managing claims effectively.  Equally important is the ability to understand what the facts mean in context.  Deer hunting is still a popular pastime in Wisconsin.  As such, one avenue for investigating whether a person’s condition is as disabling as they claim is to find out if they hold a deer hunting license.  The idea being that a person who is able to hunt for deer is probably less disabled than they claim.  The inference is strongest in the case of hunting with a bow and arrow because compound bows require significant strength to use and their shorter range (compared to a gun) generally requires the hunter to climb into a tree stand to hunt.  Deer are also heavy, which would make it difficult for a lone hunter to deal with the animal after a successful kill.  You will note that several assumptions are required to make the leap from the premise “claimant possesses a deer hunting license” to the conclusion that “the claimant is less disabled than alleged.”

The assumptions need to be teased out before the fact of possessing a hunting license can be used to infer less disability than alleged.  Take the following hypothetical:  a relatively young person who is right-handed alleges a disabling work-related right shoulder injury (rotator cuff and SLAP tear) that prevents him from returning to his former occupation that requires he be able to lift up to 100 pounds to his waist occasionally and 15-25 pounds above his shoulder frequently.  In the course of the investigation, the claims professional discovers that the employee obtained a license enabling him to hunt deer in Wisconsin with a crossbow.  The claims professional considers this to be a red flag and evidence that he is not as disabled as he claims.  She sets up an independent medical examination and informs the expert of this fact, expecting it to be significant.

The question we must consider is whether the employee’s crossbow hunting license is in fact evidence that he is not as disabled as he alleges.  The first thing we need to know is a bit about crossbow hunting in Wisconsin.  Until 2014, the only persons who could obtain a crossbow license to hunt deer were persons with a physical disability that prevented them from being able to use a vertical (and typically compound) bow.  This should immediately give us pause in our analysis since it suggests that the employee’s license very well may have been obtained because his right shoulder condition prevents him from using a standard vertical compound bow.  This possibility is bolstered when one considers that the draw weight (how many pounds of force are required to draw the string back) on a compound bow for an average-sized man will be around 60 pounds.  For a right-handed shooter this puts a tremendous amount of stress on the right, or draw-hand shoulder. 

But what about dealing with a deer that has been shot and killed?  Wouldn’t that be physically difficult?  It is true that most whitetail deer killed in Wisconsin will weigh over 100 pounds, with some bucks tipping the scales at well over 200 pounds.  Obviously field dressing, dragging a deer out of a field or woods, and lifting into a vehicle would require significant effort.  However, we are again making assumptions about what physical activity the employee is doing.  We must consider the possibility that the employee uses a four wheeler to get to his hunting location, as many hunters now use four wheelers.  We must also consider the possibility that a hunter with a four wheeler also has a power lift on the vehicle to help get the carcass off the ground and onto the four wheeler.  In addition, we must consider the possibility that the employee hunts with other people and will have assistance if he makes a kill.  The point is that we cannot infer from the employee’s license to hunt deer with a crossbow that he will engage in physical activity exceeding his alleged level of disability. 

The above scenario demonstrates the importance of not only knowing the facts of a claim but also of knowing what those facts mean.  Without a clear understanding of what the facts mean, one can misinterpret how the facts effect the claim.  In the above scenario, it is possible that the claim could be considered suspect based on the assumption that a person seeking a hunting license is probably less disabled than they claim to be.  However, knowing a bit more about hunting suggests the fact that a person who claims to have a disabling shoulder injury and seeks a crossbow hunting license is probably behaving consistently with the alleged disability.  Not drawing out the most reasonable inferences from the known facts could very well compromise one’s ability to effectively administer a claim.  Investigate carefully, but know what the facts turned up in the investigation really mean.

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