The criteria the insurance companies look at include:
1. The injuries documented by an ICD-9 Code;
2. The modalities of care documented by a CPT-Code;
3. Intensity, frequency and duration of all medical care;
4. Types of doctors seen including any specialists;
5. Age, weight, and height of injured person are reviewed;
6. "Special damages" like wage loss, and out-of-pocket expenses are reviewed;
7. Any interference into the personal life (duties under duress, and loss of enjoyment of life damages);
8. Is there a permanent impairment to any particular body part documented under the American Medical Association (AMA) guidelines, and if so, what percentage under the Whole Person Method?
All of these criteria are condensed into a comprehensive review to ascertain case value. If the injury is caused by a car accident, then property damage to both vehicles is important and evaluated by most insurance companies. Thus, if the injured person’s vehicle has low property damage (anything under $1,500), then it becomes important to analyze the types of vehicles involved; whether there is movement in the bumpers on any of the vehicles involved; whether the at-fault party or anyone in the at-fault party’s vehicle was injured, and the total damage repair to the at-fault party’s vehicle.
It is important to understand the review process for claim value because it is highly detailed and complicated. It becomes paramount that the injury attorney you use for your claim is proactive in gathering all the relevant documentation that will help support your case value.