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Getting Claims Started: Talking to Doctors

You need to know up front that adjusters look to your medical records for all the information regarding your injuries and pain and suffering.  When it comes time to make a Demand, the adjuster will not consider any claim for injuries or pain/suffering unless it is mentioned in your medical records.  If it is not in your chart, it didn’t happen.

Knowing this should change how you talk to your doctors.

The biggest component of your personal injury claim is your medical treatment.  It is extremely important that you seek out prompt medical attention if you are hurt.  Your pain and suffering, and the total value of your claim for that matter, hinges on the total amount of your medical bills and the type and quality of medical treatment.  Any delay or “gap in treatment” between the date of accident and the time you see a doctor will be used by the insurance company to argue you were not hurt because if you really were hurt you would not have waited to see a doctor.

Key Records Effecting Your Claim:

  1. ER Report
  2. X-Ray and MRI Radiology Reports
  3. Other Diagnostic Reports
  4. Medical Provider Discharge Summaries
  5. Medical Narratives

Getting Your Injury Claim In The Chart

When you are getting medical treatment, it is important that:

  1. You tell doctors about ALL your injuries.  You want to do everything possible to get all your injuries listed in the doctor’s notes/records.  If the injury is not in the records, it did not happen and the adjuster won’t consider it.  Or, you forget to tell the doctor about an injury for a couple of visits and then remember.  The adjuster will say this is a gap and being used as an excuse to build a bigger claim (i.e. you are lying to add on more injuries to bolster your claim).  The best thing to do is get all your injuries down in your record on the first visit or when you first begin to feel them.
  2. If you have hard injuries (broken bones, joint injuries, herniated discs) you need to ask your doctor about the long term affects, such as arthritis or limited mobility as you age.  You want to do this for three reasons. First, you want to understand for your own purposes of knowing what you are up against in the future.  Second, you want to understand the consequences so you can put them in your Demand as future pain and suffering and be able to argue with the adjuster about the value of such long term consequences.  Third, you hope the doctor puts something down in your chart discussing the long term affects, such as permanent impairment ratings, so the adjuster sees it documented when he/she reviews your records.

Now you shouldn’t tell the doctor to write down stuff.  You just need to mention everything possible so that the doctor hears it and will hopefully note it in your chart.  Use ClaimClinic’s HTT Worksheet (Head-to-Toe) the night before seeing your doctors to take an inventory of all your aches, pains, and injuries.  This tool will help you identify all your pain and suffering.

Miscellaneous Items

Auto Accident Medical Bills

Get and save copies of all your bills, even if they are being submitted to a health insurance company.  These will serve as an important double-check when you go to put together your Demand Package.  Also, if you are in a No Fault State, you need to watch your medical expenses carefully to see if you go over the Personal Injury Protection cut-off amount.

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