July 23, 2022
HOW INSURANCE ADJUSTERS USE MEDICAL RECORDS AND BILLS TO REDUCE YOUR SETTLEMENT
Insurers consider your medical bills, treatment, injuries, and wage loss information when determining the value of your personal injury claim. If you do not follow these simple rules, your claim may be doomed from the start. Remember, the adjuster is not on your side and is not trying to give you what your case is worth, even if they are your insurance company. They are trying to protect their insured and give you as little as possible. So, for that reason you must be proactive because the insurance adjuster will closely scrutinize your medical records, looking for ways to reduce your claim’s value. Therefore, make sure you stay away from these potential red flags that can destroy your claim.
- Did you get treatment immediately after the accident or shortly thereafter? Insurance adjusters love to see accident victims refuse medical treatment or put off medical treatment for as long as possible. The longer you wait to get treatment, the more likely the adjuster will allege that the injuries you got treatment for were not caused as a result of the accident, or were pre-existing injuries that just got aggravated by the accident. Remember, you cannot recover for pre-existing injuries, but you can recover from aggravation to the body parts that were previously injured, especially if you had not been having any treatment or pain prior to the new accident.
- Did you have a break in treatment? Insurance adjusters love it when injured people have breaks in treatment. If you are injured, do not quit the necessary treatment or take breaks in treatment ordered by your doctor. When you don’t finish or take breaks in treatment, any further treatment will not be considered by the adjusters and they will not take your case seriously.
- Are your medical bills proportional to your claimed injuries? Insurance adjusters look for consistency between the injuries claimed and the amount of medical bills incurred. Is the treatment excessive or not related to the injuries claimed at the emergency room. Running up unneeded treatment or fraudulent chiropractic or therapy bills does not help your case. Lastly, it is never a good idea to go to doctors, MRI facilities, or chiropractors who work with attorneys to get you unnecessary treatment. Adjusters know about the law firms that send soft tissue clients every to the same groups for unnecessary treatments.
- Soft tissue injury claims, also called whiplash or low back pain, are the main injuries where fraud takes place. If you are alleging whiplash, expect the insurance adjusters to review your records and bills with a fine tooth comb. “Build up” 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 and chiropractic treatments that continue on and on, with no reduction in weekly visits and no appreciable improvement, are always suspect. Expect the adjuster to cut your bills and treatment and allege overcharges and excessive treatment.
- 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. A two-week hospital scan tay and two months of physical therapy are much stronger evidence of an injury than a few thousand dollars’ worth of diagnostic tests and chiropractic treatment. Broken bones, scars, and surgeries are taken seriously by adjusters. Orthopedic surgeons and neurosurgeons are taken much more seriously by adjusters than chiropractors. Although, there are some excellent chiropractors in Huntsville and Decatur that do great work and we recommend them to our clients under the right circumstances.
- Do your medical records suggest a lack of causation? Does your medical records mention pre-existing injuries or prior accidents? Was your back and neck injured in a prior accident? Have you seen an orthopedic surgeon or chiropractor for the same injury you allege you sustained in this case? Have you complained of prior pain to your doctor? Is there any reference to intoxication, alcohol, or drugs in your medical records? Does anything in your medical records deviate from the official description of the accident that has been represented to the adjuster?
- Is there a correlation between the medical records and treatment received? If a medical report does not accompany each set of bills, the adjuster usually disregards those charges.
- What is the quality of the medical information provided? Chiropractic notes and therapy notes that all say the same thing day after day is viewed with skepticism. Narrative reports from well-respected doctors and surgeons explaining the nature of your injuries in detail are best. Hospital records with detailed nurses’ notes are also excellent sources of information on your injuries.
- What did you tell the first doctor you saw after the incident? Expect the adjuster to scrutinize the medical records of the ambulance personnel and your first doctor visit. If the history taken does not mention the accident, your case is dead in the water. The adjuster will argue that your injuries are not related to the accident. Further, if you don’t get treatment for weeks for any reason, all of your treatment will be questioned by the adjuster. People seriously injured get treatment immediately.
- What is the reputation of your treating doctor or chiropractor? Is your doctor or chiropractor known for specializing in treating patients with insurance claims? Does your doctor or chiropractor advertise for personal injury victims? If so, the doctor’ and chiropractor’s credibility will be suspect, as will the validity of your claim.