Vegas Personal Injury Law Blog

1. In order to maximize your recovery on any auto accident personal injury case you must seek appropriate medical attention immediately after an accident. A delay of only a few days in obtaining medical treatment will reduce the value of your claim by insurance company standards.

2. In the event that event you are not at fault for an accident, insist that a law enforcement be called to the accident scene.

3. In any event that you are at fault for an accident, it makes sense to a try to negotiate with the other driver to determine if he wants to handle the claim outside of auto insurance. This can be helpful in minor accidents, because even minor accidents are considered at fault accidents by your insurance company. These small accidents will add up and will eventually affect your insurance rates. If you can work with the other driver on property damage, assuming that there is no injury from the accident, this can save you the expense of increased insurance rates and can expedite the repair of the other driver’s vehicle.

4. Especially in any questionable liability situation, do not admit fault for the accident. This can be considered an admission. Your statements can be admitted into evidence in any legal proceedings as an exception to hearsay.

5. If you do not obtain follow-up medical treatment after your emergent treatment, this is a red flag to an insurance company.

6. You must cooperate with your own insurance company. You are required, as a condition of coverage, to answer their questions about the accident. You’re not required to answer any questions from the other side’s insurance company. If you have an attorney, do not give any statements to the adverse insurance company or sign any forms without the approval of your attorney.

7. Do not attempt to settle your case until all necessary medical expenses past and future have been determined. I had a consultation recently involving a auto accident injury claim, where a lady settled her injury claim with the adverse carrier for $1000, despite the fact that she had continuing low back pain and pain radiating down into her lower extremity. Then, a few weeks after the first accident she was involved in a second motor vehicle accident. Obviously, this decision to settle the first accident claim was not well thought out.

8. Keep track of all of your medical expenses. Ask your health-care providers for copies of your bills so that you can determine the costs of medical treatment for your auto accident. You may be surprised to learn to how much things like MRIs, CT scans and pain management procedures cost.

9. In the event you receive a traffic citation as a result of an accident do not pay the fine. Try to get an attorney to handle the ticket for you. In most cases the ticket can be reduced to a parking ticket and nolo plea can be entered. With this plea the ticket cannot be used to determine liability in a civil proceeding.

In my 25 years of experience as a personal injury attorney, I have dealt with many of the healthcare facilities in the Las Vegas area, who treat patients that have been involved in accident cases.  

Some physicians that deal with personal injury cases on a regular basis are aware of the following office procedures that can be extremely helpful on personal injury claims and lawsuits:

1. A Clean Bill.

It is extremely helpful for a personal injury attorney to have a clean bill.  What this means is that the bill contains only the dates and amounts of all charges by the healthcare provider.  A clean bill does not contain any information on health insurance payments and also contains a figure which represents total charges for services rendered by the provider for the accident.  In the event that the attorney receives a bill with insurance payment information, this devalues a claim because the adverse carrier knows that first party insurance has paid all or some of the patient’s bill.  If an adverse adjuster knows that bills are paid by first party insurance, such as auto med pay with no right of subrogation, he will offer a lesser amount to settle the claim.  Also, an attorney cannot file any documents with the Court that contain a patient’s social security number.  This data must be redacted. Don’t include the patient’s social security number on your bill.   Bills that are submitted to the Court as evidence in a personal injury case must also be redacted for insurance information.

Health insurance claim form(s) are particularly problematic for personal injury attorneys because the insurance information is replete throughout the form and redaction of insurance information is a very time consuming process.

For these reasons, personal injury attorneys love clean bills.

2. Organization of a personal injury medical file.

For reasons stated in No. 1 above, all information regarding insurance should be placed in one section of a medical file.  Once again, the reason for this is because all insurance information must be redacted from medical records which are the subject of a trial.  If all of the insurance information is kept in a separate section of a file and segregated from the medical records, this is very helpful to the personal injury attorney as far as redactation of records is concerned.  Intake forms often include insurance information mixed in with patient history and symptomology.  Redactation is a simple process when all insurance information is segregated.  We can just eliminate those pages from our trial exhibits.

3. Medical necessity.

In order for medical bills to be admitted into evidence, there must be a statement by the healthcare provider concerning the medical necessity of the treatment.  In other words, the treatment must be medically necessary for the treatment of injuries resulting from a particular accident.  Generally speaking, this statement of medical necessity is very helpful to an attorney during an arbitration or a short trial.  In these proceedings, it is not necessary for the doctor to actually appear to give testimony in the event that his medical records contain a statement of medical necessity and other evidentiary requirements.  The doctor in his discharge report or in his medical records can simply state that, “In my opinion, all treatment rendered to the patient (from first date of treatment to last date of treatment) was medically necessary to treat injuries that the patient received in her accident of (date of accident).

4. Medical causation.

In order for a Plaintiff to prevail in a personal injury case, medical evidence must contain a statement by a physician concerning causation.  That statement can be, “It is my opinion to a reasonable degree of medical probability the injuries that I diagnosed and treated the patient for were caused by the accident of (date of accident).”  The healthcare provider can simply include such a statement in his records or narrative reports.
5. Reasonable and Customary Charges.
This statement is extremely helpful on mediation, arbitration and short trial cases.  

In order to admit a medical bill into evidence, the attorney must lay a foundation that the charges for the medical treatment were reasonable in amount and are customary charges for same or similar services in the Las Vegas area.

The physician in his narrative or medical records can once again simply state that, “I have reviewed the billings for this patient.  In my opinion, the charges for services rendered by my facility were reasonable in amount and customary charges for the Las Vegas medical community.”  Once again, this information will eliminate the need to have the medical provider actually testify in an arbitration or short trial proceeding.  This is especially important if there are numerous medical providers.  Attorneys can’t afford to bring all providers to a short trial.  Even if you win, you can only receive $500.00 per expert.

In the event that the healthcare provider does not provide information concerning medical necessity, causation and reasonable and customary charges, the attorney can provide the healthcare provide with an affidavit that he can sign which can be used in mediation, arbitration and the short trial program, so that the medical bills and records of the provider meet legal foundational requirements for admissibility.

6. Depositions.

The healthcare provider should be prepared during deposition to testify concerning medical necessity, causation and reasonable and customary charges.  Oftentimes, healthcare providers during deposition have absolutely no idea of what their facility charged the patient.  They are ill-prepared to testify on matters of reasonable and customary charges.  Many physicians have never seen their client’s bill.  In preparation for a deposition, the healthcare provider should review his bill and the charges and be prepared to testify concerning reasonable and customary charges.  The healthcare provider should also understand and be prepared to testify concerning opinions on medical necessity and causation.  Most healthcare providers give adequate testimony concerning their records, but are very weak when it comes to their testimony in these three areas.

7. Timely Production of Bills and Records.

Most lay persons would be surprised to know how long it takes to receive medical bills and records from some healthcare facilities.  Sometimes, it takes months to receive bills and records.  Healthcare providers can charge .60¢ per page for their records.  We find that most healthcare providers are unaware of delays by their office concerning requests for bills and records.  The faster that the attorney can receive the bills and records, the more quickly he can settle the client’s personal injury claim, and pay the client’s healthcare providers for services rendered.  

We find that staff turnover is largely responsible for delays on requests for bills and records.  We have the most problems with outside billing companies that provide billing services for multiple providers.  Outside billing services are a nightmare to work with.  They are hard to reach and are more non-responsive to attorney office contact. 

When we attempt to obtain a complete copy of the entire medical file during a deposition, we are often told by the healthcare provider that they can’t provide a copy of the bills and records.  This must be done by advance notice.

With litigation, time limitations are always involved.  Therefore, if a provider delays in providing the attorney with bills and records, this may contribute to sanctions on the part of the attorney, or dismissal of the case, if records cannot be provided in a timely manner.  If the patient is still treating as his case approaches a trial date, any new records and bills must be produced prior to the discovery cut-off date, which is usually 45 days prior to trial.

8. Balances.

Information concerning total charges and balances is very important to the personal injury attorney.  One would think that an attorney just makes a call to a healthcare provider and he can immediately obtain information on total charges, and any balance that is due and owing, after payment by insurance, and after application of provider discounts.  We find that oftentimes we cannot get this information from the healthcare provider.  We need to have this information in order to settle cases, and to participate meaningfully in mediation and settlement conferences.  Once again, it should not take weeks or even days in order to obtain this information.  The attorney’s office needs access to this information.  Once again, this problem is magnified when outside billing company’s are involved.

9. Reductions.

In order to get cases settled and to meaningfully participate in settlement conferences and mediation, it is necessary for the attorney to know ahead of time what reductions the healthcare provider is willing to accept.  During the mediation or settlement conference, if an offer is made, the attorney must be able to tell the client what he or she will end up with as a net recovery during the proceeding.  The attorney does not know how much money will be offered to settle the client’s case.  Therefore, the attorney will contact the healthcare provider, usually in writing (via fax) for pre-approved reductions prior entering into a mediation or settlement conference.  Most healthcare providers are not aware of how mediations and settlement conferences work.  It appears that mediation and settlement conferences currently are being utilized more frequently in an attempt to resolve claims.

10. Custodian of Records Affidavit.

In order to authenticate medical bills and records for admissibility into evidence, it is necessary for the attorney to authenticate these documents.  This can be done with a Custodian of Records Affidavit.  My office, as a matter of procedure, sends  with every request for bills and records, a Custodian of Records Affidavit.  These certificates are sometimes ignored by healthcare providers.  Generally speaking, we receive bills and records without an executed Custodian of Records Affidavit.  The medical records, for purposes of litigation, cannot be admitted into evidence without the Custodian of Records Affidavit.  Most judges will not admit bills and records into evidence without the executed Custodian of Records Affidavit.  In order to respond to the affidavit properly, the healthcare provider should be able to provide a notarized signature by the Custodian.  Our office, as an alternative, will send two Custodian of Records Affidavits.  One has a form for notarization, and the other has a statement stating that the custodian signs under penalty of perjury.  The second alternative may not work with some judges.  Therefore, it is critical if the Custodian of Records has access to a notary for proper execution of the Custodian of Records Affidavits.

11. Arthritis Defense.

Most personal injury cases involve injuries to the neck and back.  The defense of these claims largely involves concentration on degenerative arthritis or degenerative changes in the spine.

The healthcare provider should not let the defense attorney set up their case by catching the healthcare provider off guard to comment on pre-existing degenerative changes that appear in the patient’s diagnostic tests.  For the most part, I have been informed by healthcare providers that degenerative changes such as spondylosis are generally asymptomatic.  These degenerative changes increase the susceptibility of the patient to risk of injury.  This is very important on low impact auto accident cases.  Degenerative changes may decrease the injury threshold for an accident, increase the length of treatment, and produce more chronic conditions.  Therefore, it is important for the healthcare provider to understand the concept because anytime a diagnostic test shows degenerative changes, the defense will concentrate on this in an effort to defend the case, and to attempt to show that any symptomology that the patient had post accident was due to degenerative changes, and not to the subject accident.

12. Medical Records From Other Healthcare Providers.

It is the position of our Discovery Commissioner that a healthcare provider can testify on medical records from other healthcare providers that are in his file.  There are two types of medical experts.  The treating physician and the medical expert.  The treating physician can comment on medical necessity, and the reasonable and customary nature of outside healthcare referrals without being designated as a medical expert.  These types of charges involved MRI’s, and referrals to specialists like orthopedic doctors and neurologists.  The healthcare provider should be able to testify that the services provided by these outside facilities were medically necessary, and that their charges were reasonable and customary.  Obviously, it will be necessary for the doctor to not only request a copy of the medical report from the referred facility, but also must obtain a copy of their bill.

All of the areas covered in this blawg should be common knowledge to healthcare providers that are involved with personal injury cases.  We have seen a tremendous turnover in medical facilities that deal with personal injury cases in recent years. Many of the new healthcare providers that are treating patient’s on personal injury cases, do not have much experience at litigation.  The information contained in this blawg is critical to the healthcare provider in understanding his role in assisting his patients on injury claims and during litigation.

Obviously, from the get go of a personal injury claim, it is very important to determine its potential value. An even more important question is, how much can I recover on my personal injury auto accident claim? The value and the potential recovery of your personal injury claim are not the same. The first question that must be answered is, what is the maximum potential recovery of my personal injury claim?

To determine what the maximum potential recovery of your personal injury claim, you must first know how much insurance is available. The first thing to determine is how much liability insurance does the adverse driver have? In the State of Nevada, this can be determined by the use of NRS 690B.042, which simply states that an adverse carrier must release proof of liability insurance upon receipt of a medical authorization and a list of your health care providers. Sometimes, we can get a general idea of how much insurance is available by taking a look at the adverse driver’s insurance company. Generally speaking, major insurance carriers like State Farm, Farmers, and Allstate, are companies that will write liability policies above the statutory minimum. The minimum liability insurance in the State of Nevada is $15,000.00 per person and $30,000.00 per accident. Other company’s only write minimum policies, because these company’s are not as financially solvent as the major carriers. These marginal insurance companies try to limit their exposure by only writing minimum liability coverage policies.

Once you have determined how much liability insurance the adverse driver has, the next thing to do is to look for additional liability insurance policies that may be applicable to your personal injury claim. In the event that you have an adverse driver who is not the owner of the vehicle, the owner’s liability coverage will provide primary liability coverage, and the driver’s liability insurance policy will provide secondary liability coverage. We also know that commercial policies will generally carry higher limits that personal auto policies. In the event where you have an employee driving his employer’s vehicle, this may be a case where there are two liability insurance policies available for your personal injury claim.

When you determine that the adverse insurance policy is at least a $100,000.00/$300,000.00 policy, this is a sign that there may be an umbrella policy available that can provide additional liability coverage. An umbrella policy generally provides excess liability coverage in the amount of $1,000,000.00. In cases involving large businesses, their coverage is generally layered, so there may be one company that writes the initial liability policy and other companies that write layered excess policies.

After your attorney has determined how much liability coverage is available on your claim, the next thing to do is to look at your own insurance coverages. In the event that you have med pay coverage on your Nevada auto policy, you do not pay back your insurance company for the medical bills that they pay from any recovery that you receive from the adverse party. Med pay will generally increase your net recovery. However, off-sets for med pay coverage will apply under circumstances where you make an uninsured motorist claim or an underinsurance claim with your own company. For additional information on this subject, please refer to my blawgs on auto insurance coverage.

After you have determined all of the available insurance on your personal injury claim, you will be able to determine your maximum potential gross recovery. In rare cases, the person who caused the personal injury may have the ability to pay beyond any insurance coverage he or she may have. However, this should never be counted on as a source of compensation.

The reality of personal injury claims is that many of them have a value in excess of applicable liability coverages and underinsurance coverage.

Can you get more from the adverse insurance company rather than the adverse liability limits? In the event that any insurance company receives an offer to settle your claim within it’s liability policy limits and they refuse to settle your claim within their liability limits, and you obtain a judgment against the adverse carrier party in excess of his insurance coverage, you can attempt to receive an assignment from the adverse party of his bad faith cause of action against his own insurance company. This will allow you to file suit against the adverse in an attempt to make the insurance company liable for the excess judgment. This does not happen very often, and this is the exception rather than the rule on personal injury claims.

After you determine the maximum potential gross recovery for your personal injury claim, the next step is to determine how much your personal injury case is worth. This is difficult to determine at the beginning of a personal injury claim. However, there are some basic rules that apply.

The first general rule is that the greater the amount of property damage to the vehicles involved in an automobile accident, the greater the insurance companies perceive the potential is injury and, therefore, for a higher recovery. Insurance companies do not like to take cases to trial where the property damage to the involved vehicles is devastating.

With the application of new technology to the bumper systems of vehicles, a person can be involved in an injury accident without visible property damage to the involved vehicles. Insurance companies hate these cases. Insurance companies refer to them as “minimal impact soft tissue cases” or “low impact cases.” In the event that you have a low impact claim, the insurance company will most likely only make a minimal offer to settle your claim. In the event that you do not have med pay coverage to cover your bills, your case will generally end up in litigation. Juries may not be sympathetic to individuals who claim to be injured in low impact cases. Defense attorneys try to convince the jury that injuries are not to be believed or that the motivation in bringing the lawsuit is for secondary gain.

For example, if you are involved in a low impact accident and you have a spinal surgery, the insurance company will hire doctors, engineers and biomechanical experts who are willing to testify that the accident did not create an injury potential.

Another important factor increasing the value of your personal injury claim is egregious behavior on the part of the adverse driver. Was he drunk? Was he using drugs? Was he engaging in a speed contest or reckless driving at the time of your accident? Does he have a felony record? Egregious conduct on the part of the adverse driver can raise the value of your claim. Juries don’t like these Defendants.

Your pre-existing injury and prior treatment, if any, can effect the value of your claim. If you have no pre-existing conditions related to your injury and you had no prior treatment for a similar injury, your claim will be worth more. If you are claiming a neck or back injury and you have had prior treatment for conditions involving your neck and back, or if you had prior claims involving injury to these body parts, an insurance company will offer less money to settle these claims.

As previously mentioned in my insurance blawgs, all accident claims are indexed on a nationwide computer database that is used by most insurance companies. Once an adverse carrier receives your date of birth and/or your Social Security number, they can obtain information on your prior claims.

Auto accidents with no comparative fault are worth more. If you were involved in an auto accident where comparative fault on your part is involved, this will also decrease the value of your claim. Insurance company’s will fight claims involving comparative negligence. If your comparative negligence for an accident was minor, such as 10%, the adverse insurance company will try to magnify that comparative negligence in their favor, and this will drastically reduce the value of your claim. In Nevada, If your comparative negligence is 51% or greater, you cannot recover from the adverse driver.

You can usually determine how much contempt an insurance company and their computers have for your auto accident personal injury claim by the amount of their initial offer to settle your claim. If you have medical bills that are in excess of $15,000.00, and the insurance company makes an initial offer of $1,000.00 to settle your claim, you will generally be involved in litigation in order to resolve your claim.

Many people think that the more medical bills they have on a personal injury case, the higher their recovery will be. This is not always true. In the event that you have $15,000.00 of physical therapy or chiropractic treatment, without a referral to an M.D., and without a positive diagnostic test, the treatment will generally be considered excessive by the insurance company. Remember, the adverse driver is only responsible for medical treatment that is both medically necessary and not excessive. Therefore, your claim has more value if you have further substantiation of your injuries through diagnostic testing and evaluation by a medical doctor. Keep in mind that if you have a high medical bills relating to an auto accident claim and your treatment is on a lien basis, you will still be responsible for your medical bills in the event that you lose your case.

There are additional factors which have a tendency to increase the value of your personal injury claim.

Insurance company’s do not like visible injury, or injuries that can be clearly depicted by diagnostic tests such as x-rays. In the event that you have black and blue marks, swelling, open wounds, scarring, broken bones, deformity, etc., resulting from an auto accident, your case is more likely to settle. Claimed injuries that have no visual component to them, are generally worth less. Visible injuries are very easy for juries to understand. If they are present, jurors have a tendency to assess more value to visible injuries, than non-visible injuries.

If you have verifiable wage loss from an accident, this will give your claim more value. If you are unable to work, this usually validates a more serious injury.
Permanent physical disability, such as the loss of function of a part of your body, or disfigurement will add value to your claim. A permanent partial disability evaluation can add to the value of your claim.

Loss of family, social, and educational opportunities such as missing school, missing work related training, inability to go on a vacation, or to attend a recreational or special events, will add value to your claim.

In the event that you have emotional damages such as stress, embarrassment, depression, or strains on family relationships, inability to take care of your dependents, inability to take care of a young child, or interference with sexual relations can add value to your claim.

Medical expenses are called “special damages” or “specials”. General damages are for pain, suffering, inconvenience, and loss of opportunities.

Most people think that personal injury auto accident claims are worth some multiple of their medical bills. In other words, if you have $5,000.00 in medical bills, that you multiply that figure by 3 to get the value of your claim. Insurance company’s do not like these multiplier arguments, because increased medical expenses will result in a higher value of your claim.

Wage loss is generally compensated dollar for dollar. In the event that you use a sick day for paid time off as a result of your injuries or treatment, or if you lost wages as a result of your injuries, this is generally compensable on a dollar for dollar basis. No multipliers are used to evaluate lost income damages.
Most people think that our civil justice system will award them adequate compensation for their auto accident related losses. As a personal injury attorney, I have seen circumstances where juries award very little compensation to an auto accident victim. On the other hand, I have also seen situations where the jury will award much more than what a claim is actually worth, especially in situations involving egregious conduct on the part of the Defendant.

I have been told that to a certain extent, the reputation of a personal injury attorney goes into the formula for determining the value of a claim. The peer rating of your attorney or his success in trying personal injury cases, can add value to your claim. However, sometimes good attorney’s will actually lose cases, and bad attorney’s will sometimes win bad cases.

If you have an injury that will cause you to have pain and suffering in the future and cause you to incur future medical bills, this will add value to your claim. (Caveat: insurance companies don’t like future damages and have a tendency to downplay them.”)

As you can see, calculating the total amount of the value of your personal injury auto accident claim is not easy. Juries struggle with placing a price on things that do not normally carry a monetary value.

Consider these things in your decision to litigate your personal injury claim.
Some insurance adjuster’s will make a commission on your claim, in the event that they settle your claim for less than the authority provided to them by the insurance company. Therefore, adverse adjusters under certain circumstances may have a monetary stake in your claim.

Unfortunately, it is a very expensive and time consuming to take a personal injury claim to trial. Most medical experts will charge $5,000.00 to $10,000.00 for their trial testimony. You may need several experts or treating physicians to testify on your behalf at the time of trial.

In my experience, I find that in personal injury cases, you will either end up with juries that are sympathetic to an injured individual, or they will not be sympathetic. As soon as a juror during voir dire(questioning) mentions that he has had a claim for injury, he will probably be stricken by the defense. Pro-Plaintiff prospective jurors are usually more honest and forthcoming during questioning than jurors that are defense oriented. Defense oriented jurors generally have some hidden agenda or prejudicial feeling toward injured parties that may or may not be discovered during the voir dire questioning process.

Most personal injury accident claims settle before litigation. In order for a personal injury attorney to successfully settle a personal injury claim, it is sometimes necessary for the attorney, the health care providers, and health insurance carriers to compromise their financial positions on a personal injury claim in order to provide adequate compensation to the injured party.

The information provided in this blawg can assist you in determining the worth of your personal injury claim. It can also assist you in making the critical decision to either settle or litigate your personal injury claim.

If you have been injured in an automobile accident and will be making a claim against an insurance company, in addition to your wage loss, you are entitled to damages for your medical bills and your pain and suffering.

Today, most insurance companies use computer programs to evaluate the value of auto accident claims. One computer program will evaluate your medical bills, and another will evaluate your physical and mental pain and suffering.

Data entered into the insurance company computer on the pain and suffering program will come from your medical records. Therefore, it is very important that you not only adequately explain to your doctors and/or therapists the nature and extent of your symptoms, but you must also tell them about the affect that these injuries are having on your body function and your life. This the only way that this information can get in your doctor’s notes. The computer will not consider anything that is not in your doctor’s records. This is why 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.

General damages compensate you for physical and mental pain, suffering and inconvenience. You must assist your doctor so that he can make better chart notes. The following are the most important value drivers on your injury claim that should get into your medical records:

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 loose your job; or, if you are working so that you can support yourself or your family, this should 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 because of your injuries.

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.

SYMPTOMS AS REPORTED TO YOUR DOCTOR

These are important things to tell your doctor in describing 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, legs or feet;
7. Jaw sounds or jaw pain often accompany 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 in an accident.

Make sure you accurately report your symptoms to your doctor on each visit, even if you told him 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.

Your doctor should do re-exams every 4-6 weeks, to check your progress or lack of progress. If he does not, remind him.

Your use of braces or home exercises or home therapy should be reported to your doctor on each visit.

Use of medication, even over-the-counter medications, should be reported to your doctor on each visit.

If your injury changes your ulcers, diabetes, or hypertension from stable to unstable, this must be reported to your doctor.

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.

Absence of an x-ray or other diagnostic tests on a soft tissue injury is a red flag.

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.

Do not use the term “better” to explain any symptom. This will be interpreted that the symptom has resolved. 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.

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.

I will explain more about the computer evaluation of auto accident claims in my future blawgs.