Healthcare and Your Personal Injury Claim - How Insurance Companies Evaluate your medical treatment records - PART I

Posted Thursday, August 18, 2011 by Chris Thayer

One of the main questions that comes up with my personal injury clients is how do insurance companies evaluate these claims? In most cases the majority of the information that the insurance adjuster will rely on is included in your medical records. They will evaluate the diagnoses you received for your injuries as well as the documented severity, frequency of visits, the type of care received, duration of injury, and whether you have any significant permanent symptoms which may require future treatment.

This blog entry will address frequency of treatment. In my experience, this issue comes up often, as jaded and skeptical insurance adjusters review a claimant’s medical records. Sadly, insurance companies will effectively punish those who try to “tough it out” and avoid going to the doctor. In such cases, the insurance company will conclude that the claimant must not have been injured badly (or they would have gone to the doctor more often). Conversely, if you seek “too much” treatment (a subjective assessment), then insurance companies will argue that you “overtreated” and will not want to pay for the treatment.

Advice? Make sure you are communicating clearly with your treating healthcare providers about your symptoms. Make sure to explain how your symptoms are impacting your life, and whether or not you are experiencing any improvement. You should always follow the advice of your medical provider, however, if you find that the treatment being provided is not helping you get better, you should be proactive about referrals to specialists, getting 2nd opiniond, or trying other modalities to treat your condition.

Unfortunately, there are some conditions which modern medicine cannot cure and chronic pain can set in. In such situations, it is easy to fall into a pattern where you seek treatment that helps you “get through” the day, but does not help cure the underyling problem. In such challenging situations it is all the more important to consult with an experienced personal injury attorney who can help guide you through the claims process. The internet is too public of a forum to discuss all issues related to insurance claims.

If you have questions, you should contact me for a free initial consultation to discuss your matter privately and confidentially.