red flags in medical records

Do Your Personal Injury Medical Records Have Red Flags?

Experienced Attorneys Fighting for Injury Victims in Connecticut

Medical records are, by far, one of the most important pieces of evidence that your attorney will present during your injury case. Whether you are submitting a claim for a slip and fall, nursing home abuse, or medical malpractice, your medical records are the subject of scrutiny from the moment when the claim begins.

To decide on your proper amount of damages – especially when future medical treatment is required – your records and professional examinations are used to reveal the extent of your injuries, ongoing problems, and the costs of your experience.

While your personal injury attorney will use your medical records to help you, the defense will use medical records to lower your settlement amount. They will utilize every red flag possible. To avoid long court battles over discrepancies and errors, it is important that you know the role that your medical records play, how they are used, and what red flags could be detrimental to your claim.

How Medical Records Prove Damages

Medical records are the biggest pieces of evidence that justify the damages requested in your lawsuit. Any hospital, physician, therapist, and other healthcare provider records will prove the injuries you sustained in the accident, your pain, and treatments administered. Also, these records help prove how the injury affected you, and how it could potentially affect you for the rest of your life.

Due to the power of medical records, it is imperative that you seek medical attention right away following an accident. The earlier you establish records proving your injury, the better your chances will be for obtaining maximum compensation.

The Defendant Has the Right to Request Records and an Examination

The defendant has the right to access all evidence that you and your attorney have collected. Aside from your medical records, the defense may request a medical examination. This is common when the defense is an insurance company. The insurer requests the Independent Medical Examination (IME), wherein a doctor of their choosing examines you and reports his or her findings to the insurance company. Diagnostic scans and laboratory testing may be conducted during the IME. The physician who completes the IME will issue a report about the extent of your injury, the effect it has on your life, expected treatments, and your prognosis.

An Insurance Adjuster and Defense Attorney Are Trained in Questioning Any Evidence that Does Not Correlate with Statements

Realize that it is the job of the insurance claims adjuster and/or the defense attorney to question anything that does not make sense. While you might be telling the truth about your injuries, if your medical records do not match those claims, the insurer and defense attorney will question the validity of your statements. When they become suspicious, they will vigorously investigate all facts and pieces of evidence. So, it is important that all records and evidence reflect your statements.

Common Red Flags That Might Harm Your Case

1. Degenerative Changes Noted

Degenerative changes are any concern that shows up on your diagnostic imaging scans, such as a CT scan, x-ray, or MRI. These changes are the normal result of aging, but they can be used as evidence to contest the validity of your injury claim.

Degenerative changes are only an issue in middle-aged or elderly victims, but there are some who will experience degenerative changes as early as their 20s. If your imaging scans for your treatment show degenerative changes, the adjuster may try to claim that your injuries – including soft tissue injuries – were the result of degenerative changes, and not of the accident.

Your personal injury lawyer will review your imaging scans for degenerative changes in conjunction with a healthcare professional. By reviewing and catching these potential issues, your injury attorney can work on proving that any degenerative changes were only aggravated by your incident, such as increasing pain. Your healthcare provider will likely be called to testify that, even with degenerative changes, those changes were not affecting you until after you were involved in the accident.

2. Prior Accidents or Previous Injuries

The insurance claims adjuster will review your medical records looking for evidence that you have prior injuries in the same area. For example, say you played sports and suffered a sports injury to your back. Then, you were involved in a motor vehicle accident years later, which also injured your back. The adjuster may try to discredit your injury and call it a previous injury. However, testimony from your healthcare provider can show that, even with a prior injury to that same area, the current accident aggravated or worsened it.

3. Gaps in Accident Treatment

Any time there are gaps in your treatment, the insurance adjuster or defense attorney will flag the records. Significant gaps could be seriously detrimental, unless there is a valid explanation for those gaps.

While you might consider grinning through the pain or just hoping that the pain will resolve itself on its own, it is in your best interest to always seek medical treatment following an injury. Waiting days or weeks to receive treatment gives the defense team the argument that your injuries were not as serious as you claim in your lawsuit, even if they truly were.

It is also imperative that you not only seek initial treatment, but continue with any follow up treatment or plans that your healthcare provider recommends. Failing to attend appointments or stopping treatment in the middle will be questioned by the defense team.

If you disagree with a physician’s recommendation, you do not have to complete the treatment. However, you must consult with another physician to establish a paper trail and prove that the proposed treatment was unnecessary or that another treatment option was better for your condition. Do not stop all treatments or ignore a physician’s prescriptions.

4. No Initial Complaint of Injury

The insurance adjuster will scrutinize every detail in your medical record, and will specifically look at the emergency room admission records following the accident.

Unfortunately, this is an unfair but common tactic. After an accident, the human body releases adrenaline; when combined with confusion and rushing, this can mask pain symptoms. You might tell a physician in the emergency room that you have back and neck pain, but the adrenaline masks your headache. A few days later, the headache worsens and you start experiencing additional symptoms.

After more follow up, it is discovered that you have a traumatic brain injury. The adjuster may try to claim that, because there was no initial complaint, the injury was not the result of the accident.

The testimony of a medical professional can combat this tactic. A professional can explain the chemical processes of the brain, as well as show evidence regarding how long brain injuries take to exhibit symptoms, for example.

5. Unreasonable or Unnecessary Treatments Used

Adjusters may try to dispute damages when they decide that a portion of your treatment was unreasonable or unnecessary. They could pick out specific treatments or deny all treatments from a facility. Say, for example, that you are in physical therapy. The therapist recommends a six-month rehabilitation. You follow the physical therapists and your physician’s requests, and you recover. However, the recovery time from the adjuster’s point of view is only two months, so they argue your additional four months was unnecessary.

Adjusters will sometimes try to throw out small treatments, like ultrasounds or massages given at a chiropractor’s office. They may deem these treatments unreasonable. Sometimes, follow up diagnostic scans are listed as unreasonable. Regardless of this, your physician’s testimony can establish that the diagnostics or “unreasonable” treatments were required for you to recover.

How to Combat Disputed Damages and Red Flags

While you cannot correct your medical records, there are things that you and your personal injury law firm can do to limit the damage from any of the above red flags. Some things that you and your Connecticut injury lawyer can do include:

  • Using supporting documentation. Any time the defense or adjuster questions something, your accident and injury attorney will supply supporting documentation. If, for example, your previous injury has come into question, your attorney will find medical records proving that you had a full recovery from that past injury; this can show that the current incident only aggravated it.
  • Supplying causation letters. A causation letter from a licensed physician treating you can prove that the injuries and symptoms you encountered were caused by the accident. The letter should include details such as the injury, treatment, prognosis, and any relevant medical opinions.
  • Using expert witnesses. Sometimes, your Connecticut injury attorney may need to bring in an expert witness to recreate the accident and prove how that accident caused your injuries. When treatments are questioned, a professional can testify as to the reason behind those treatments, their benefits, and how they help or improve your specific injury.

Avoid the Hassles of These Red Flags – Speak with an Experienced Attorney

Most red flags in medical records can be addressed by your lawyer before they become an issue. An experienced personal injury attorney knows which common disputes arise in a personal injury case, and what evidence insurance adjusters use for determining a settlement.

When you suffer a serious injury, speak with the attorneys from Berkowitz and Hanna LLC. Contact us today to schedule a no-obligation case evaluation. Call 866-479-7909 or contact us online to get started.