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Medical Treatment: Overview

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 personal injury 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 you would have seen a doctor ASAP if you were.

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

Everything you tell a doctor or nurse can end up in your records.  Medical records are the single biggest piece of evidence adjusters use to evaluate your pain and suffering.  That is because they are a third-party’s notes and not your own self serving statements that adjuster’s view cynically as bolstering your claim.  While it is absolutely imperative that you be truthful with your medical providers and provide them with any facts or information they ask you about (so you get the appropriate care), you should remain cognizant that anything you say could be written down in your records.

Considerations While Getting Medical Care

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

  1. You tell the doctor’s about ALL your injuries.  You want to do everything possible to get all your injuries listed in the doctor’s notes/records.  Adjusters follow the rule: If the injury is not in the records, it did not happen.  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.  If 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 or that you are bolstering your claim by adding injuries.
  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 so the adjuster sees it documented when he/she reviews your records.
  3. Don’t tell the doctor to write down everything.  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.
  4. 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.
  5. At the end of your treatment, ask your doctor to assign you an impairment rating if you are not completely healed.

Requesting Custom Reports

There are at least 2 different reasons why you may want your doctor to write a custom report for you:

  1. You will have future problems (future treatments, procedures, or pain) stemming from your injuries.
  2. You will never be completely healed and will be partially disabled and need a permanent impairment rating.

In these instances you want to consider requesting your doctor write a Report or Narrative.  They are also useful for getting on paper (i.e. your chart)  conversations you and the doctor have had concerning your future pain and care (i.e. prognosis) that do not otherwise appear in your medical records.  If the adjuster does not see the fact in your records, it did not happen.  So a report can fill in the gap for you.

The doctor is going to demand a fee for reviewing your records and writing the report so you want to make sure the money is worth it.  Doctors usually charge several hundred dollars for the Report.

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