How Adjusters Use Medical Records to Reduce Your Settlement

Looking for Red Flags

Hi, this is Dave Steinberg. I'm an attorney in the state of Maryland, and one of the areas that I cover is personal injury. Today, we're going to discuss how adjusters use medical records to reduce your settlement.

Insurers consider your medical bills as the primary basis for valuing your claim. So, for that reason, the adjuster will closely scrutinize your medical records, looking for ways to reduce your claim's value. In particular, adjusters will look for the following red flags in your medical records:

1. Are Your Medical Bills Proportional to Your Claimed Injuries?

Insurance adjusters look for consistency between the injuries claimed and the medical bills incurred. Adjusters develop a sixth sense as to when the medical bills are out of alignment with the nature and severity of the injury.

Soft tissue injury claims, also called whiplash or low-back pain, are prime candidates for "buildup." Buildup is a term of art among adjusters which refers to the act of increasing medical bills incurred, to artificially inflate settlement value by treating excessively for an injury.

Physical therapy treatments that continue on and on, with no reduction in weekly visits, and no appreciable improvement are always suspect.

2. Quality of Your Medical Providers

In addition to the amount of your medical bills, the source of those bills will be important to the adjuster. In the eyes of an adjuster, a two-week hospital stay and three months of formal physical therapy are much stronger evidence of an injury than a few thousand dollars worth of diagnostic tests and chiropractic treatment.

3: Do Your Medical Records Suggest a Lack of Causation?

Do your records include a notation about prior claims or injuries? Is there any mention of a pre-existing condition or an injury to the same body part? Is there any reference to intoxication, alcohol, or drugs?

Does anything in your medical records deviate from the official description of the accident that has been represented to the adjuster?

4: Is There a Correlation Between the Medical Records and Treatment Received?

Adjusters become suspicious if the medical bills submitted lack corresponding medical reports. Those reports are considered by the adjuster to validate the diagnosis made, treatment given, and your future prognosis.

5: What is the Quality of the Medical Information Provided?

Fill-in-the-blank medical reports are viewed with skepticism. Narrative reports from well-respected doctors explaining the nature of your injuries in descriptive detail are best. Hospital records with detailed nurses' notes are also excellent sources of information on your injuries.

6: What Did You Tell the First Doctor You Saw After the Incident?

Expect the adjuster to scrutinize the medical records of the first-paragraph caregiver, focusing on the history given. If that history says nothing about an accident, or attributes the injury to a pre-existing condition, expect that an adjuster will argue that your injuries are not related to the accident.

7: What is the Reputation of Your Treating Doctor?

Is your doctor known for specializing in treating patients with insurance claims? Does your doctor advertise for personal injury victims? If so, the doctor's credibility will be suspect, as will the validity of your claim.

To Recap

• Are your medical bills proportional to your claimed injuries?
• Where were you treated?
• Do your medical records suggest a lack of causation?
• Is there a correlation between the medical records and the treatment received?
• What is the quality of the medical information provided?
• What did you tell the first doctor you saw after the incident?
• And, what is the reputation of your treating doctor?

This is Dave Steinberg, and I'm happy to discuss your situation. You may contact me anytime at 301-589-4597.

Don't ignore the injury you've sustained from an accident. You deserve to be compensated for any injuries due to someone else's carelessness. Call 301-589-4597 or email me at ds@dsteinlaw.com today for a free consultation.