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Injury Claim Evaluation By Computer

Settlement by Computer
By Victor 1558 on Flickr

The same insurance companies with TV ads featuring lizards, friendly hands and smiley faces also methodically feed injury claim information into a computer which crunches the data it feels like crunching and spits out a number.

Specific medical documentation is required to establish and optimize any recovery for injuries.  This is yet another reason never to do something as serious as a personal injury claim on the “do-it-yourself” plan.  Medical documentation is scrutinized not only by insurance company claims adjusters, supervisors and regional managers but more importantly by computer evaluation programs.

What Personal Injury Claim Evaluation Software Does

Only certain aspects of a personal injury claim match recognized evaluation components in the software.  Only some data adds to the settlement offer.  Before presenting any claim, my office reviews medical and other documentation, identifying and highlighting components that the insurance company will actually use in evaluation forms, data fields and evaluation software.

This has nothing to do with ‘coding’ or medical codes that health providers must include in their billing forms to get paid.  Personal injury criteria include things such as extent and duration of disability.  Another example: in a dislocation, the bone, the extent of dislocation, and even who diagnosed the dislocation make a difference.

One client came to me over 6 months after a car accident.  The insurance company failed to make an offer.  Medical bills, collections, and hospital discharge notes filled a thick file.  But, nothing clearly specified crucial elements of the diagnosis, prognosis, or an often overlooked but vital legal requirement called causation.Obtaining, reviewing and presenting medical documentation, knowing the claims process successfully resolved that claim.

Unfortunately, software technology is relied upon heavily by the insurance industry to come up with injury claim settlement offers.  This removes the vital human element.  The only way to have a fair shot is to have an attorney who knows what criteria count in the evaluation to correctly present your claim.

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Attorney Myers is a member of the American Trial Lawyers Association, Massachusetts Academy of Trial Lawyers, and New Hampshire Trial Lawyers Association. The Law Offices of Andrew D. Myers offer a broad range of legal services in personal injury cases in Massachusetts (MA) and New Hampshire (NH) areas.

The information on this web site is offered for informational purposes only. It is not offered as, and does not constitute, legal advice. Laws vary widely from state to state. You should rely only on the advice given to you during a personal consultation by a local attorney who is thoroughly familiar with state laws and the area of practice in which your concern lies. This web site must be labeled advertisement in some jurisdictions.