Insurance claims involving lead contamination require an investigation beyond a child's medical records. (Photo: iStock)

More claims & cases

This renewed concern means more claims related to lead poisoning, a condition the Centers for Disease Control and Prevention (CDC) calls the “most preventable environmental disease among young children.”

But to truly understand the medical records and history in those case files and get to the bottom of the cause, insurers need to explore more than just the patient's health information.

Everything from whether the child ever lived outside of the country to what products the family uses to the child's own genetic history are critical for a fully informed review of a lead poisoning case or claim.

Related: Get the lead out: Drinking water contamination claims and liability

While water is a frequently a source of lead contamination, other factors can like toys and residue from a parent's job should also be considered. (Photo: Shutterstock)

Aware for decades

The public and officials have been aware of the dangers of lead for decades. In the 1950s, the first cities started passing laws about lead-based paint. The federal government didn't take action until the 1970s.

In 1978, legislators banned the residential use of lead-based paint. When coupled with the phase down of the use of lead in gasoline, researchers documented a big drop in the average blood lead levels in the United States.

These days, the most common sources of lead aren't from house paint or gasoline, but regular exposure to things such as toys, nutritional supplements, water in lead pipes, or residue from a parent's occupation and dishware, among other items.

According to the American Academy of Pediatrics, the annual cost of childhood lead exposure in the United States is $50 billion. Lead toxicity is blamed for the loss of 23 million IQ points among children and is attributed to 20 percent of cases of AD/HD.

Lead paint chips have been a frequent cause of poisoning in chiidren. (Photo: Shutterstock)

Today's goal: Prevention

Now the focus is on stopping lead exposure before it happens. According to the CDC, there is no safe blood lead level in children.

“Even low levels of lead in blood have been shown to affect IQ, ability to pay attention and academic achievement,” according to the federal agency. “And effects of lead exposure cannot be corrected.”

Federal agencies and states across the United States have enacted their own lead laws to reduce lead poisoning rates. Here are some basic facts to know about lead poisoning, how it's diagnosed and who is at risk, according to the CDC:

• A simple blood test, which is covered by Medicaid and most private health insurance, can measure lead levels in a child. For those enrolled in Medicaid, all children are required to receive screening tests at age 12 months and 24 months. Any child between 24 and 72 months with no record of a previous test should receive one, according to the Centers for Medicare and Medicaid Services.
• All children should be screened for lead poisoning, but those ages six months to six years, who live in or regularly visit “deteriorated old buildings,” are the highest priority group.
• Children with unexplained seizures, neurological symptoms, abdominal pain and other symptoms, which could indicate lead poisoning, should be tested. So should children with developmental delays, slow growth, hyperactivity, hearing loss, anemia and behavioral disorders.
• A lead level of 5 micrograms per deciliter in a child indicates a “blood lead level of concern,” according to the CDC, and requires medical management.
• Medical treatment is recommended when the level is greater than or equal to 45 micrograms per deciliter of lead in the blood.

Car keys, jewelry and some toys may contain lead. (Photo: Shutterstock)

Assessing exposure

The American Academy of Pediatrics recommends pediatricians assess lead exposure risks at well-child visits until a child is six. Tests, however, are recommended only if the assessment indicates there is risk that a child could have been exposed.

The academy's lead exposure risk assessment seeks answers to the following questions:

• Does the child regularly visit or live in a house built before 1978 with peeling or chipped paint?
• Has the child or family lived outside the United States?
• Does the child have a sibling or family member being followed for lead poisoning?
• Does the child frequently put things in his mouth such as toys, jewelry or keys?
• Does the child eat nonfood items because of a disorder such as pica?
• Does the child frequently come into contact with an adult whose job or hobby involves exposure to lead?
• Does the child live near an active lead smelter, battery recycling plant or other industry likely to release lead? Or, does the child live near a heavily traveled road where soil and dust could possibly be contaminated with lead?

When investigating a lead claim, include a complete review of medical records for the child and other family members. (Photo: Shutterstock)

Full medical review required

While the results of a blood test for lead may be simple to read, for attorneys and insurance adjusters, lead poisoning cases aren't always clear cut. Many factors – not just the old building where they attend daycare or regularly visit their grandmother – must be investigated.

If you're looking over a lead poisoning claim, here is the medical information that's essential to build any case:

• Complete medical records, including infant and child growth percentiles with height, weight and head circumference measurements; labs; and documentation of well-child check ups.
• All testing and lab results for the individual.
• A full medical history of family members, including their genetics, that could identify any underlying medical, developmental or cognitive issues that could account for or contribute to the allegations of lead poisoning.
• Research into the individual's geographic area, especially the town and building in question, to uncover any other claims or possible environmental factors such as lead in the water.

Children can pick up lead from household dust, soil, dishes or toys that have been passed down for generations. (Photo: Shutterstock)

More than medical records needed

Attorneys and adjusters also must look beyond the medical records. Here are other questions you should ask about the claimant:

• What are the parents' occupations? Could a child be picking up lead from residue left on their parents' clothes and shoes, or tracked in from their workplaces? The National Institute for Occupational Safety and Health lists nearly two dozen jobs that could lead to lead exposure.
• Does the family use Mexican folk remedies which may contain lead, such as greta, azoque and azarcon? The CDC lists other folk medicines that may contain lead.
• Is drinking water contaminated with lead?
• How old is the claimant? Babies and toddlers are at the highest risk because they play on the floor, picking up contaminants on their hands and skin and putting anything in their mouth.
• Does the child chew on toys, which possibly contain lead paint? Since 2008, the Consumer Product Safety Commission has recalled about 50 toys because of lead.
• Are foods stored in containers high in lead such as leaded crystal, pottery or pewter?
• Is the claimant exposed to household dust which contains lead from lead paint chips or contaminated soil brought in from the outside?
• How is the child doing in school? Are there behavioral and cognitive test results to review?
• Have a developmental behavioral pediatrician, toxicology specialist and genetic specialist been consulted? Some genetic disorders can cause cognitive and neurological disorders that at first glance may appear to be lead poisoning. These experts could provide critical information into the child's well being.
• Do other family members, especially children, have elevated levels of lead? If not, genetics may be the culprit.

After all, genetics and not lead exposure could cause learning delays that might be attributed to lead poisoning. A favorite old toy, passed down from a grandparent, could be full of lead. Or, grandma's remedy for colic could be behind the high lead levels.

In other words, a clear understanding of the clinical, genetic, cognitive and environmental presentation – and not just the medical history – is critical when analyzing an alleged case of lead poisoning. Attorneys and adjusters who don't have the full picture could miss the details that might just make or break a case.

Kari Williamson, BS, RN, LNCC, CCM ([email protected]) is the president of MKC Medical Management, and works with attorneys, insurance examiners and others within the medical-legal-insurance space to better manage and understand claim issues.

• Explore more than the patient's health information.
• Be familiar with the common sources of lead poisoning – e.g., toys, pottery, nutritional supplements, lead pipes.
• Federal agencies and states have enacted their own laws.
• Children exhibit a number of symptoms related to lead poisoning that require additional testing.
• A full medical review includes the family history in addition to the patient.