Essential to creating a successful claim is the proper documentation of your car accident injuries, a task that can be made even more difficult by that fact that more often than not, your medical information will not be handled by an adjustor, but rather by a computer. The purpose of this article is to help you communicate with your doctor about how he or she should document your injuries, and is written expressly to your doctor.
Today in personal injury, a doctor’s comprehensive medical examination, history and prognosis are tossed aside by the insurance industry in favor of norms embedded in silicone. The complex evaluation of your injury, which was in the past handled by a trained adjuster, is in many cases now delegated to a machine. For the sake of your patient’s insurance claim, it is important to understand what this machine considers in its evaluation.
It goes by various names—perhaps the best known is “Colossus.” We are going to discuss facts and considerations you should be aware of in an effort to speak to the computer in a manner that will more clearly communicate your patient’s injury. If the computer is better able to understand your patient’s injury, it is given the opportunity to more justly evaluate the need for compensation, in part to pay for the care that you have provided.
As with human communication, it certainly helps to speak the same language. The computer’s language is comprised of ICD-9 codes. Accordingly, all diagnoses should likewise be rendered in ICD-9 codes. In addition, it is also important to consider that computers, not unlike their human programmers, have a very small vocabulary when it comes to understanding what insurance companies euphemistically refer to as a “soft tissue injury”—a name the insurance industry uses to imply that if soft tissue is involved, the injury is somehow less compensable. Here is a list of some words, which, if they apply to your patient, may communicate the injury more effectively:
Limited range of motion
Headaches
Dizziness
Anxiety (if it is treated by a mental health professional)
Spasms
Radiating pain
This list of words is certainly not exhaustive, and use of these terms must be clearly substantiated and quantified for their impact to be understood by the insurance company computer. The nature, causal relationship to the injury, dates and duration must all be set forth in your notes.
I hope this information has been of value to you and your patient. This material is in no way exhaustive, but if the factors discussed are accurately reflected in your charts, the nature and extent of your patient’s ca accident injuries will be more properly evaluated by insurance computers. And if it is more accurately understood by the insurance computer, a more just result may be possible.