Injury Claim Evaluation By Computer

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.

Views: 8