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Avoiding Negotiation Mistakes: Medical Files and Treatment

Posted on: December 24, 2022

Chi Hung Nguyen
December 24, 2022

Avoiding Negotiation Mistakes: Medical Files and Treatment

avoid the mistake of failing to examine medical files and bills

Insurance companies know that personal injury attorneys fight to help their injured clients recover. In many cases, recovery means getting money to pay for property that was damaged, like cars after a car accident, and for medical treatment after suffering bodily injuries. Meanwhile, insurance companies are focused on the facts of what happened, like the injured claimant’s medical file.

Part of the process of getting an insurance company settlement award is negotiation. This means the injured claimant’s attorney and the insurance company adjuster or lawyer will discuss your case until they reach an agreement. While settlement is not always the right choice, experienced personal injury lawyers know that it can save their clients time, money and the stress of going through a trial.

Insurance company adjusters carefully examine the medical records, as well as each and every detail. They know how important it is to look at the injured claimant’s medical records. For example, if there is a history of drug use, the insurance company may see it and try to use the information against the injured claimant’s case.

To combat this, the personal injury lawyer needs to know every little detail about the injured claimant’s medical history and records so that he or she can be ready to counter any facts that can weaken the injured claimant’s case, or threaten his or her recovery. When this is not enough, the injured claimant’s lawyer has to be ready to find and hire a medical expert to back up his or her claims.

Unprepared lawyers overloaded with car accident or truck accident cases may make the mistake of quickly overlooking a small detail in the medical record. Not every fact is relevant, but experienced lawyers know that they have to examine the records in detail to find out whether the fact will impact their case or not. For example, there are instances where a lawyer will settle a case for less than it was worth, or for a completely different kind of injury because he or she was not paying attention.

Other mistakes made by those who were not paying attention to the details in a medical record while handling insurance cases include:

  • Adding drugs unrelated to the treatment or injury to the injured claimant’s damages,
  • Unneeded testing to dramatically increase the cost of medical bills,
  • Including claims that the injured claimant lost wages or could not work when the claimant did not work much before the accident,
  • Sending the insurance company significantly incomplete medical reports,
  • Including tests, diagnoses, estimates and other medical records that are impossible for the injured claimant, such as visits to a women’s doctor like the OBGYN when the claimant is male, or
  • Slow, fender-bender accidents resulting in severe bodily injuries which some insurance adjusters believe mean the injury was not severe.

When a mistake like this happens, it affects how believable and capable a claimant and his lawyer may be.

Most personal injury attorneys work on a contingency fee. This means that your lawyer does not get paid unless you win your case. Most of the time, this is great news for an injured claimant because this motivates a skilled personal injury attorney to win your case and put money into your hands as soon as possible. But in some cases, the wrong attorney rushes and does not see a key fact that affects an insurance claim, or throws demands at an insurance company that are not supported by evidence. Experienced personal injury lawyers know how to handle your case the right way.

What are Medical Reports and Medical Bills?

 Medical Reports

First, this article discussed medical records in general. But there are actually a wide range of official documents that are part of all the required medical records. Medical records can include everything from the emergency room visit right after a car accident, to physical therapy, psychologists as well as anything else needed to help an injured claimant fully heal.

For example, some medical reports are reports made by one doctor or medical treatment provider to another, directing them to provide a certain type of treatment.

Medical Reports typically include:

  • The name and other identification information of the injured claimant/patient,
  • The date of the first visit,
  • The date of injury and loss,
  • The name and information of the doctor,
  • Whether there were x-rays, the doctor’s findings about the x-rays,
  • The doctor’s prognosis and diagnosis,
  • The proposed medical treatment plan,
  • The number of doctor visits,
  • Any physical therapy,
  • Surgery and hospitalization,
  • The date of the most recent doctor visit, and
  • Any documented disabilities of the injured claimant/patent.

Insurance companies use these details and information to see if every part of the medical treatment was needed, or if they should not be covered by the insurance policy.

Medical Bills

Medical bills, on the other hand, are the documents with the cost of each doctor visit and the cost of medical treatment listed and broken down. Like an invoice, an itemized medical bill helps the insurance adjuster know how much the injured claimant is asking for and each part of the bill. Usually, to be used as evidence, these medical records and bills also need to have an affidavit from the medical provider’s office or otherwise comply with the Rules of Evidence.

Warning Sign: Large Gaps in Medical Treatment

Gaps in medical treatment are also facts that a personal injury attorney should be aware of. For example, if someone goes to the doctor every day for a couple months after a car accident and then stops going, the insurance company will try to argue the injured claimant’s injuries were not that serious. Their reasoning is that if the injuries were as serious as the claimant is making it seem, then the claimant would have kept going to the doctor. Some gaps in time between doctor visits are excusable, but if many months go by, it can weaken an injured claimant’s case.

Similarly, let’s say there are two people are driving in a car and hit by a truck and they suffer similar injuries. But, one person is not going to the doctor, or he is getting less medical treatment than the other. This inconsistency can be used by insurance companies to imply that one of the claimants are dramatizing or exaggerating his or her injuries.

Of course, this is not always the whole picture. Sometimes people get less medical treatment for valid reasons. There may be gaps in medical treatment because the injured claimant could not afford to stop going back to work, despite the pain and injuries suffered. If one claimant is hurt more than the other, it could be because of where the claimant was located in the car. It could also be because of a pre-existing health condition that was made worse by the car accident.

If a claimant had a pre-existing condition that the accident made worse, the wrongdoing defendant is still completely responsible. This is sometimes referred to as the “thin-skulled plaintiff” or “eggshell skull rule.” This rule simply means that it may not matter that an injured claimant already had a pre-existing condition that made him or her more sensitive to other injuries. The defendant is still fully responsible for Lawsuit Settlements. There are many factors that affect insurance settlements.

Insurance Company’s Doctors

Just like the injured claimant’s lawyers can use the reports of healthcare providers and doctors to help support their claims, sometimes the insurance company have preferred doctors that they use to undermine the value of an insurance claim. These doctors are often making such a good profit, they make it their entire job to provide independent medical exams for insurance companies. The personal injury lawyer will have to determine whether the medical exam is really objective, or if the doctor’s opinion is being swayed by the insurance company.

Manipulating the medical records, reports and bills by poking holes in the facts is one of many insurance company tactics to undervalue your insurance claim.

This is why the right personal injury lawyer for your case will carefully examine evidence and medical records so they can be prepared to address any potential issues that may arise during settlement negotiations. When the injured claimant’s lawyer sees these facts, they know to be prepared.

Contact the right personal injury lawyer 

Without experience in the insurance industry or legal experience, understanding which factors or evidence can help or hurt your case can be difficult to understand.

Are you trying to secure your financial recovery with the help of experienced attorneys? If so, we can help.

The Pusch & Nguyen Law Firm has helped countless Texans handle their insurance disputes. Our experienced trial lawyers have gone up against some of the biggest names in the insurance industry while successfully bringing home payouts for clients. Our successful reputation speaks for itself, and with offices in both Houston and San Antonio, we are well equipped to assist Texans who are in dire need of our services. Register online for a free case evaluation or call us today at 713-524-8139 (Houston) or 210-702-3000 to schedule an appointment with a member of our team.

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