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9.2.1 Examples of inadequate description


An example of an insufficiently specific description would be 'ligament/tendon damage left knee' if the injury were in fact 'rupture to the anterior cruciate ligament left knee'. The latter, more specific description would enable future claims managers to differentiate between the accepted condition and a later, non-compensable injury to the fibular collateral ligament of the same knee.

General descriptions such as 'shoulder injury', 'knee injury' or 'low back pain' should not be used at all. All reasonable efforts should be made to find a specific diagnosis and it is this specific medical diagnosis for which we accept liability.

It is also important to avoid expressions which sound medically impressive but are in fact nothing more than references to pain, e.g.:

  • 'Fibromyalgia' = muscular pain or tenderness, especially when diffuse or non-specific
  • 'lumbago' = any painful condition of the lower back.

In fact Delegates should not usually accept 'pain' however described, as a compensable matter. Pain is usually a symptom, rather than a medical condition in its own right.

Nevertheless, there are exceptions, i.e. psychological ailments where pain occurs without physical cause. These pain syndromes, if present, should be noted as such.  Similarly, 'stress' is not an acceptable description of a psychological disease. A more specific diagnosis of the actual claimed condition is required.