How Will My Personal Injury Case Be Evaluated

You have been injured in an accident and will be making a claim against an insurance company.

Today, most insurance companies use computer programs to evaluate the value of injury claims.

Data entered into the insurance company computer program will come from your medical records. Therefore, it is very important that you adequately explain to your doctors and/or therapists about your injuries and the effect that these injuries are having on your body and your life, so that this information can get in your doctor’s notes. Chart notes are the most important aspect of claims evaluation. Your doctor must do these notes right in order for you to maximize your recovery for general damages.

General damages are damages for physical and mental pain, suffering and inconvenience. You must report to your doctor the following, so that he or she can make better chart notes. These are the most important value factors on your injury claim:

1. Duties Under Duress

This means that you are working in pain. Tell your doctor about the symptoms that you experience while working. If you are working because you don’t want to lose your job; or, if you are working so that you can support yourself or your family, this must be reported to your doctor. Tell your doctor if there is a change in your ability to do your job or if you lost a promotion.

If you are a student, and you are experiencing pain while sitting in class, carrying your books; or, if you can’t concentrate in class, this information needs to be in your doctor’s notes.

If you experience pain while doing indoor domestic activities, such as washing the dishes, vacuuming, making the bed, cleaning your house, this must be reported.

If you have pain while doing outdoor household activities like gardening, washing the car, cutting the grass or taking out the garbage, these are things that you should tell your doctor about.

If your hobbies, social activities or sports are affected by your pain, or if your ability to perform in a sport has changed, your doctor should know this.

These are important things to tell your doctor about your injury:

1. Loss range of motion in your neck, back or extremities;
2. Muscle spasms – these are the only truly objective symptoms of soft tissue sprain and strain injuries;
3. Ringing in the ears;
4. Numbness, tingling, and loss of function in an extremity;
5. Tell the doctor if your pain is your pain on one side or both sides of your neck, mid-back or low-back.
6. Radiating pain is pain moving from your neck to your arms and hands, or pain in your low-back going to your hips or legs;
7. Jaw sounds or jaw pain often accompanies a neck injury;
8. Anxiety (fear) and depression often accompany soft tissue injuries;
9. Headaches often accompany neck injuries and can last a long time. Report these to your doctor on each visit;
10. The duration of your pain is important. Tell your doctor if it is constant or intermittent, and describe to him what activities make it hurt or make it hurt worse;
11. Pain in the shoulders that doesn’t radiate from the neck, can be a symptom of rotator cuff injury. This injury is often caused by bracing yourself with your arms.

Make sure you accurately report your symptoms to your doctor on each visit, even if you told him or her about your symptoms on the last visit. For example, if you have a headache on the first visit that lasts for seven (7) months, and you only tell the doctor about it on the first visit, the computer will default this symptom to one week duration.

1. Your doctor should do re-exams every 4-6 weeks, to check your progress or lack of progress. If he does not, remind him.
2. Your use of braces or home exercises or home therapy should be reported to your doctor on each visit.
3. Use of medication, even over-the-counter medications, should be reported to your doctor on each visit.
4. If your injury changes your ulcers, diabetes or hypertension from stable to unstable, this must be reported to your doctor.
5. Delays in obtaining treatment and gaps in treatment are red flags to the computer. Delays in treatment, from a week to 30 days, or gaps in treatment will be interpreted by the computer as fraud.
6. Absence of an x-ray or other diagnostic tests on a soft tissue injury is a red flag.
7. Physical therapy without a referral from a doctor or chiropractor is a red flag. Prolonged physical therapy more than three (3) times a week, for greater than three (3) months, adds little value to your claim.
8. Do not use the term “better” to explain any symptom. This will be interpreted that the symptom has resolved.
9. You should not tell your doctor that you are “better” just to stop treatment. You should always report any residual symptoms to your doctor at the time of discharge, so that he can make an accurate prognosis and state his opinion about your probable future pain and suffering, your need for follow-up care or home treatment, and how much that will cost.
10. If you have a disability, such as impaired function or range of motion loss, your doctor should consider sending you for a permanent partial disability rating. If you have a 2-3% disability, the computer will interpret this as a permanent change in the quality and enjoyment of your life, adding sometimes considerable value to your claim.