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Medical Treatment: Analyzing Records

As we mentioned in the ClaimClinic Binder System, you need to have 2 copies of your medical records before you analyze them.  There is a clean copy that you will ultimately send to the adjuster as part of your Demand Package. Then, there is your working copy.  This sits in your Claim Binder and you will mark it up with highlights and notes, noting every piece of evidence in your chart that either helps or hurts your claim’s value.

You are Looking For:

  1. Doctors’ notes and comments
  2. Descriptions of your injuries and pain
  3. Treatment notes
  4. How you responded to treatment
  5. Discharge summaries – they contain prognosis and future treatment notes

Dissecting The Data

Are you ready to dig into the heart of your personal injury claim?  You are now going to DISSECT your medical records to find and record all the data adjusters use in their software programs.  You will need to have your WORKING COPIES of your medical provider’s records for this important task.

If you didn’t put your records in chronological order before making a working copy, you will need to do it now.  Go through and put them in order from the date of first treatment to the date of your last treatment.  You should also go through the clean copy and put those records in the same order so the adjuster has the benefit of being able to read the records in chronological order.

Now grab a highlighter.  Go page by page and highlight all the following on each date of service (your record for a single day of treatment may be more then one page):

  1. The Date you were there (called the Date of Service).
  2. The doctor, physicians assistant, or person who saw you that day.
  3. Every single symptom, complaint, or pain level – Symptoms include things like neck pain, stiffness, sleeplessness, lack of range of motion, muscle spasms, headaches, anxiety,  numbness, and radiating pain.
  4. Every single diagnosis – These are all the “labels” the doctor puts on your injuries.  Some of the more common ones are cervical sprain/strain, subluxation, contusions, and concussions.
  5. Every single treatment – These include physical therapy, ice/hot packs, chiropractic adjustment.
  6. Every singe test or diagnostic – The most common are x-rays and MRI’s.
  7. Every single prescription that is either prescribed, refilled, or that the doctor notes you are currently taking.
  8. Every single limitation that you either told the doctor you are having problems doing or that the doctor notes you can’t or should not do.  This can include things such as sitting restrictions or lifting restrictions.
  9. All ICD9 and CPT codes.  ICD codes normally appear in your records and look like xxx.x – three digits with a decimal point and a number behind.  CPT codes normally appear in your bils.

Using The Dissection Worksheet

Now that you have gone through your medical record once with a highlighter and making notes, it is time to pull all that data out into the Dissection Worksheet.  You are going to use your Dissection Worksheet when the time comes to write your Demand.  The worksheet will have all the meta-data about you treatment already broken down and categorized for you. That way you don’t have to spend hours flipping through pages of your records.

Go ahead and print out a Dissection Worksheet for each set of records you get in.  The first sheet of the Worksheet has a checklist to help you work through the administrative/organizational side of getting in records for your claim.  Now, lets walk through each section of the Worksheet and show you how to do it.

General Info

Date of Accident (DOA) – Write down the date (month, day and year) of your personal injury claim.  This will be helpful when looking at dates of service so that you can quickly jog your memory on dates.

Physician’s Name – Write down the doctor, chiroprator, or other medical provider who treated you.  This should be the top most expert whose name appears in your records.  For the ER, it will be the ER doctor.  It could also be your primary care physician, your orthopedic doctor, your physical therapist, or your chiropractor.  You are going to need to refer to his/her name later in the worksheet when you note who is writing stuff in your chart.  Also, adjusters commonly use doctor names and not practice names when talking about medical treatment.

Total Cost of Treatment – This is the total medical expense for this provider.  Add up all the dates of treatment using the provider’s bill.  Next to this field you will see a “referenced with bills reminder.”  Compare the dates of service (DOS) in your records with those in your bills.  Make sure you have the same DOS and same number of appointments.

Dates of Service Information

This section is relatively straight forward.  You are going to look at your treatment dates for this provider at a very high level.  Almost all claim software looks at this data about your treatment.  It will give you a good sense of the extent of treatment you received from a time perspective.  For some providers, like an ER Hospital visit, the dates section will only have a single date/appointment in it.  That’s okay.  If you want a quick way to count the number of days between two dates, like for the days between your date of accident and first treatment or the total number of days of treatment, use an online day calculator.

Overall Impressions

You should only fill this in after you have read through your entire medical record.  This section is meant to get you thinking critically about what the best and worst facts/arguments are contained in your chart.  These are helpful for you to set expectations as well as giving you arguing points for your Demand or Negotiations.

Accident & Liability Facts

Many of your medical records will have notes about the collision – how it occurred.  The most helpful records in this regard are usually the EMT/ambulance records and the ER records because they are the closest to the actual accident.  You want to write down all the facts they note about your accident.  These normally include such things as:

  • wearing seat belt
  • air bag deployment
  • loss of consciousness
  • severe property damage

Symptoms & Complaints

Write down each symptom that appears in your records.  These can be things like:

 

Typical Personal Injury Symptoms
Range of Motion NeckMuscle Spasms NeckNausea
Range of Motion ThoracicMuscle Spasms LumbarNumbness left right arm
Range of Motion LumbarAnxietyNumbness left right leg
Range of Motion ShoulderHeadachesDizziness
Neck PainCervical Sprain StrainLimping
Neck StiffnessLumbar Sprain StrainDecreased Concentration
Upper Back PainSleep DisruptionLoss of Balance Coordination
Lower Back PainFatigue

For each complaint or symptom you find, note the first day it appears in your records and the last day it appears.  Then, figure out the duration of days between the two dates.  Now you have evidence of how long each complaint or symptom lasted.

Injuries

Just like symptoms/complaints, write down every single injury the doctor or medical provider diagnoses.  Then write down the date it was first noted.  Finally, write down the injury’s or diagnosis’s ICD-9 code.  ICD codes are a system of coding injuries for hospitals and billing purposes.  For personal injury claims, the most common are:

Look through both your medical records and the bill for the provider.  A lot of times the ICD9 codes will be buried/hidden in the documents somewhere.

Treatments

In the treatment section of the Dissection Worksheet you will list all the treatments you received.  These include such things as:

Typical Personal Injury Treatments

Prescribed MedicationsChiropractic ManipulationElectrical Muscle Stimulation
Physical TherapyHeat PackCold Pack
Massage TherapySelf ExerciseAquatic Therapy
Injections – CortisonInjections – SteroidsTraction
Home TractionCervical Sprain StrainLimping
Neck Stiffness

For each treatment you identify in your records, you want to note the first day it was done and the last.  This will give you a duration for each treatment.  You also want to find the CPT Code for each treatment.  CPT stands for Current Procedural Terminology.  They are 5 digit numbers with no decimal points that are assigned to every task and service a medical practitioner may provide to a patient including medical, surgical and diagnostic services. They are then used by insurers to determine the amount of reimbursement that a practitioner will receive by an insurer. Since everyone uses the same codes to mean the same thing, they ensure uniformity.  You can look up CPT codes based on key words using the American Medical Association’s website.  Every doctor’s office is different in terms of whether they list every CPT code for every treatment.  A lot of times they don’t.  It is in your best interest to spend some time looking up the CPT code for each treatment you identified because claim software uses these codes a lot.

Testing & Diagnostics

Testing and/or diagnostics will usually be such things as MRI’s and X-Rays.  It can also include blood work (if related to your injuries) or electrical nerve conduction studies (if you are having carpal tunnel like symptoms).  For each test or diagnostic you identify, list the date of service it was performed and whether the test/diagnostic was positive for evidence of injuries.

Medications & Devices

Write down every prescription you were given by this medical provider and the dosage.  Note the 1st day it was prescribed to you and the last time it was re-filled or prescribed to you as well.  Then, figure out the duration.  Your use of prescriptions is evidence for your pain and suffering.  The frequency and amount of prescriptions you are taking should coincide with your levels of pain and injuries.

Also note devices such as crutches, splints, air casts, or cervical collars.  Do the same thing for the date of first and last use and the number of days between.

Duties Under Duress

Duties under duress are those things/duties in life that you continue to do despite the pain caused by your collision.  Duties are usually broken down into different categories:

  1. Work
  2. Domestic Duties
  3. Household
  4. Studies/Educational

You want to comb through your records to see if the doctor wrote down any of your complaints that you told him/her about and how they were affecting your life.  These can appear both in intake forms your doctor uses when you first come in and in the his/her daily notes.  For each category listed above, try to identify the following types of duress:

  1. Mobility/Stability Problems: climbing, kneeling, lifting, walking
  2. Dexterity Problems: finger or wrist movements
  3. Fatigue Problems
  4. Postural Problems: bending, sitting, standing, stooping
  5. Anxiety/Depression Problems
  6. Concentration Problems
  7. Pain

For each duty under duress that you identified in your medical records, write down its category, the type of duress, and all the dates it is noted in your chart.

Lost Wages

Adjusters normally don’t give you “credit” for lost wages unless there is a doctor’s note or order telling you not to work.  This section makes sure you examine your medical records to find support for lost wages if it exists.

Causation Issues

Causation issues are things that an adjuster can use to argue your injuries were not caused by the accident.  Make sure you check and list any time a doctor or other provider mentions prior injuries to a body part you are claiming was injured.  Also, some doctors will put in their records that the car collision caused your injuries.  This is very beneficial to you (although not having it does not harm you), so make sure you list this too.

Impairment Ratings

Impairment ratings act as a claim multiplier.  This section simply asks you to identify an impairment rating already in your records and, if one does not exist, gets you to think about whether the doctor would go there for you.

Referrals

Adjusters want to see a good “chain” of how you are moving through doctors and/or specialists.  They are trained to be cynical with personal injury attorneys because attorneys will sometimes manage a claimant’s medical treatment and refer them to doctors who are very plaintiff friendly – i.e. go overboard for personal injury claimants.  Make sure you identify all the referrals a doctor made for you and also cross-reference the referrals with you Records Request Log to make sure you have gotten their chart and bill.  A lot of times a doctor you get referred to will send his/her report back to the referring doctor.  So, you many not need to get that record and just need to get the bill.

Thinking Like An Adjuster

In addition to looking for all the data that you highlighted above (and that will make its way into your Demand Package), the adjusters are also constantly looking for a couple of common issues to drive down the value of your claim.

How Adjusters Reduce Your Claim:

  1. Long time gap from Date of Accident to first doctor’s visit
  2. Pre-existing Injuries
  3. Conflicting History
  4. Signs of Malingering

Scrutinizing First Treatment

Insurance companies always scrutinize the records of the first place you received medical treatment the most.  They are looking for no complaints of pain, or no complaints of pain in areas you claim were injured.  They are also looking for you telling the doctor that you suffered from prior injuries in the same areas as you are claiming were hurt in the accident.

Insurance companies think, sometimes rightly so, that you should be complaining of pain and injuries during your first visit.  The longer the “gap” between the date of accident and the medical record’s date of service where you first mention an injury or a pain, the more skeptical an adjuster will be of the claimed injury and the more that adjuster will discount that injury.  Did you wait 2 months before mentioning that your neck hurt?  That is why it is important to:

  • Tell your treating doctors every single body part that hurts from your head to your toes, and
  • Get your medical records and review them prior to negotiating or talking to the adjuster about your injuries.

Pre-Existing or Prior Injuries

Adjusters are looking for notes in your medical records saying you hurt the same parts of your body that you say were hurt in your accident sometime before in the past.  They call these “pre-existing” injuries because they are going to argue the injury you are attempting to get money for pre-existed the car accident and was not really caused by the accident.  You may also see the doctor talk about “aggravation” of a pre-existing condition.

Different History or Comments

When you are in the ER or talking to doctors explaining what happened, the doctors and staff are writing down your comments.  Sometimes your prior comments to the adjuster will be inconsistent with what is noted in your records.  This could be a credibility problem.  That is why you should try to not talk too much about your claim until you have collected and reviewed all your records.  That way, your comments to the adjuster will be consistent with your records.

You also want to pay close attention to make sure that all your injuries appear somewhere in your records.  An adjuster is not going to give you “credit” for any injury that does not appear in your chart.  The saying is, “If it isn’t in the chart, it didn’t happen.”  Adjusters do this as a practice because they do not / cannot just take every claimant on their word.  They need to see a doctor or other medical professional acknowledging the injury.

Malingering

Malingering is a medical term used to describe a patient who exaggerates or fabricates physical injuries and symptoms for financial gain.  Sometimes a doctor will hint that he/she thinks you are not getting better on purpose.  This does not happen often, but when it does it will dramatically lower the value of your case.  A lot of the times you won’t even know your doctor feels that way about you until you read your chart.  The doctor will almost never tell you this to your face.

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