How Your Chula Vista Personal Injury Claim is Evaluated for Settlement by the Insurance Companies

You can watch the legal video on my website —www.blanelaw. com— called “How To Determine Case Value.” In the video, I explain this secret in detail. Long gone are the days where a personal injury attorney would simply triple the medical bills and come up with a quick formula for pain and suffering in an injury case. This may have worked in the 1980s, but now, the blueprint for settlement value follows a strict formula of medical based documentation. Please see the previously-discussed Secret #2 for more details about how insurance companies use computer software programs in the claim value review process.The criteria analyzed when determining value of an injury case is as follows:

The International Classification of Diseases, Ninth Edition (ICD-9 Codes), which are medical descriptions of injuries;

The Current Procedural Treatment (CPT-Codes), which are the modalities or types of medical care that must balance with the ICD-9 Codes;

The intensity, frequency and duration of all medical care. Specifics such as if an ambulance was needed or if hospitalization was completed are important in terms of the foundation of medical care given;

The types of doctors used, and whether any specialists were needed. Any side issues like gaps in medical care, or previous injuries or medical conditions are usually reviewed by entering the social security number of an injured person in a computer databank. Yes, this means your entire medical history is tied to your social security number and shared in a computer network system;

Theage,weightandheightoftheinjuredpersonandthe impact of these factors on the injured person’s recovery;

“Special damages” such as wage loss, out-of-pocket expenses, credit damages and mileage to and from doctor appointments. For example, a lost wages claim must be both supported by the employer and substantiated in the medical findings;

Any interference from the injuries in the personal life of the injured party -- known as “duties under duress” and “loss of enjoyment of life” damages -- must be properly documented and supported in the medical findings;

Finally, after an injured person concludes their medical care, the insurance company will look to see if there is a medical impairment to a particular body part. If so, the impairment must be properly documented by a medical doctor using the American Medical Association (AMA) “whole person percentage method” guidelines. Apart from the injuries themselves, it is my opinion that any impairment to a particular body part that is properly documented and substantiated by the injury-producing accident is the biggest value driver in a personal injury case today.