Secret 5: The Medical Treatment For Your Injury Will Be Closely Scrutinized By The Insurance Companies
From the moment you suffer an injury, the documentation process begins and every step you make or do not make is closely followed. Often times there is an accident report that lists the time, date, and place of the accident. Witnesses are identified. A narrative of the events causing the accident is documented. Medical treatment is rendered and records of the treatment are created. These medical records are valuable keys to the overall evaluation of the subject injury and thus the overall value of the injury claim. Three points will be considered by the insurance companies when evaluating your medical treatment: Failure to Treat Immediately Much like the accident report, the adjuster looks for medical records that document the time, date and place of the injury. The adjuster is also looking for medical documentation close in time to the injury. The rationale is simply this: an injured person seeks medical treatment close in time to the injury if the person is truly hurt or injured. Absence of medical documentation close in time to the accident supports their theory. Consistent History The medical records are generated by the treating physician and his or her nursing staff. Statements from the injured person given to the medical providers are recorded on the medical chart. The injuries reported at the initial visit with a medical provider serve as the framework of specific injuries that will be considered by the adjuster. For instance, if a shoulder injury is reported and treated at the initial medical appointment, a knee injury that is reported a month later will come under much more scrutiny and will likely be denied. Gaps in Treatment An accident occurs. Injuries are sustained. Medical treatment is provided at the emergency room and there is one follow-up appointment with the family physician. You decide to simply deal with the pain and discomfort, thinking (and hoping) it will just get better. Three months pass. The pain is still there. A return visit to the doctor results in a referral to an orthopedic doctor who now wants to conduct sophisticated and expensive medical tests. The three month gap in treatment will be a problem for the adjuster. Again, the rationale is that an injured person will seek medical treatment and will consistently continue to receive medical treatment if there is a true injury. The course of medical treatment will be discovered when all medical records are received and closely scrutinized. Know that the medical records that document the severity of the injury will be used as a tool to assist with the determination of the claim’s value.
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