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By The Numbers: "140"

140. That's the average number of pages in a basic, attorney-represented soft tissue claim. Why is this number so significant? Our research shows adjusters spend as little as 30 minutes reviewing this much documentation. This includes assessing the nature and extent of injuries, examining the types of treatment provided and charges for those medical services, and documenting their evaluation of the case.

To put this in perspective, 140 is the number of pages in a short novel like F. Scott Fitzgerald's The Great Gatsby. In 30 minutes, could you glean enough from that novel to hold a critical discussion about it? Not likely.

With the rise of social and medical inflation, the demands on adjusters for loss cost containment have grown. The problem is that, while adjusters' “rules of thumb,” developed through years of experience in reviewing medical records, may save time, today they lead to increased costs of settlement and can't be relied on. Records have become more complex. Billing is more aggressive and difficult to track. More than ever, the devil is in the details. To get a good feel for the issue, we've deconstructed the process for reviewing records to construct a review that gets results in today’s personal injury climate:

Organize records for review and reference: 30+ minutes

Records received from lawyers aren't typically organized in proper order. Just figuring out if all the needed records are available can be a chore. Putting them in a logical order and making sure they are annotated for reference is time consuming, but necessary for a complete review

Find the real injuries: 10+ minutes

Once the records have been organized for review, adjusters need to determine which injuries were actually treated. Diagnostic lists are long and misleading, as are the claims in a demand letter. Only the treated injuries have medical significance.

Investigate causation: 30+ minutes

Assessing causation means more than pointing out degenerative conditions or minor vehicle damage these days. Analysis today needs to raise the bar on the burden of proof by examining how providers discuss and evaluate the role of pre-existing conditions and assessing whether an impact would have generated the amount and type of motion necessary to cause injury.

Objectively define severity: 30+ minutes

Constructing a picture of the true severity level of injury requires close examination of subjective and objective data. Inconsistencies within reports and across medical providers requires meticulous examination. Checking diagnoses against findings and measuring the severity of injury by functional impact takes time, however, they frequently produce a profile of minor injuries with unsupported diagnostic lists.

Confirm medical justification for treatment: 30+ minutes

As more and more specialized medicine (pain management and other specialties) works its way into personal injury claims, the rate of finding care provided that isn’t medically justified is quickly rising. Determining whether treatment is justified requires research because “rules of thumb” don’t work well in a world of more and more aggressive treatment.

Reduce medical costs to reasonable value: 30+ minutes

Medical charge containment isn’t about the bottom line, it’s about each line. The difference between charges and how providers actually get paid is large and increasing.

Casentric spends hours on these cases because that’s what it takes to get it right. We scour each bill and record looking for connections and applying medical standards that adjusters don’t have the time and resources to complete. While these often appear to be “just a minor soft tissue claim,” we know that this level of analysis produces reductions in average settlements of 25% or more. We’d welcome the opportunity to show you how this approach can supplement your adjusters' work, save them time and place them in a better position to contain the total cost of settlement.

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