Who is going to pay for that Injury?

I have treated many people who were injured in an accident.  While I focused on setting the bones and providing follow-up care after surgery, there were always the behind-the-scenes legal discussions about the cause of the injuries and the future needs of the injured.  Cost of care,  lost wages, and the value of the suffering needed calculation to establish fair compensation.  The process of negotiating a settlement is a  major stress to both the injured and the involved parties.  While the physical healing has been completed,  the emotional recovery begins only after resolution.    

I provided letters for my own patients regarding their accidents and treatments.  As a treating physician,  I wanted what was best for them, and provided information on what I knew, and based on what I did for the injured person.   When determining the value of an injury, the complete view of a person’s life could have a significant bearing on the value negotiated to settle the claim.  Treating physicians may not know about the other aspects of the injured person’s life, but will answer questions about the immediate injury. 

Money seems like a crass topic when discussing the impacts of an injury.  In truth, money is how our society resolves the associated ramifications.

In the ideal perfect world,  the injured person heals completely,  without any residual problems,  has all his/her wages paid without interruption, and has the ability to participate in all their life activities without pause.

The reality includes pain,  medical treatments, emotional stress, work interruption, activities disruption,  and dispute with the parties involved in the injury.

Spearheaded by the insurance company,  there will be investigations about the cause and costs of the injury and a review of the coverage amount ( the maximum money available for a specific claim).  

Any person related to the injury will have their own perspective and anxiety. 

The attorney who represents the injured often agrees to represent them on contingency.  They will collect  35% of the total amount recovered pre-suit or 40% of the total amount if a lawsuit is filed.  Money remains the proverbial invisible hand that channels many of the decisions. 

The injured person,  the involved party who may have caused injury, the attorney who represents the injured, the insurance company claims manager,  the attorney that represents the insurance company,  the medical doctors and facilities that treated the injured, government regulators,  government payors like medicare or medicaid, all have their own perspectives and interests.  They may be many more parties of interest because of the complexity of the situation. All will have interest in the outcome, and the financial ramifications. 

All involved parties will be represented by a human being.   Each will sit at the negotiation table with their own wants,  needs, fears and anxiety.

In the ideal perfect world, the emotions associated with each party should be moderated.  The injured party should receive funds to settle all their medical, and legal fees with money set aside for future related needs,  lost wages, and for pain and suffering.

I have been engaged to look at the medical records of the injured as a consultant for both insurance companies and plaintiff attorneys.  My 30 years of medical experience combined with my growing understanding of the legal system has provided me the ability to understand the language of the injured,  the language of doctors and the languages of attorneys. Not surprisingly,  the same word or fact could mean very different things to each party.  

Because injury involves human interactions, strong personalities, and emotions can disrupt conversation.  As the consultant,  I provide information that can be used to resolve the dispute related to an injury.  In the perfect world,  emotion will give way to the facts. A fair settlement will be reached.  All parties walk away content.  The proverbial Win-Win gives relief to all. 

Unfortunately,  perfect is rare.  Many attorneys become the proverbial sharks in the pool.  Some let ego get in the way of pursuing a fair settlement. Protecting a reputation does not always benefit the client.  The injured may allow the emotions disproportionately discount the reasonableness of a settlement offer.  The business managers of the medical facilities may have incentives to negotiate for higher fees.  Each party may have difficulty appreciating the other's perspective.  Each will view the facts from their own frame of reference. Each party becomes that shark,  looking for an opportunity or a weakness. 

The presenter of the facts will need to be Orca, the killer whale, in order to overcome the outsized influence of the sharks.

That person must have command of all the information.  In the prior blog, I stated:

Since the Expert analysis is often challenged by both sides of the dispute,  the analysis must be based on the specific factors of the situation.  That means considering the information evident at the time of the analysis.  That information typically includes:

1. Mechanism for how the injury occurred

2. Timing of the presentation of the complaints

3.  Utilization of evidence-based medical treatment protocols

4. Identification of measurable findings on testing

5. Correlation of the subjective complaints to the objective findings

6. Reviewing prior medical history for similar complaints

7. Reviewing the prior medical history to rule out medical co-morbidity causes of the complaints

8. Evaluating the treatment protocols as compared to the community standard.

That was the perspective of the Medical Expert in 2016.  Now,  we have even more information.   Social media posts,  work time sheets,  credit card spending bills,  club attendance,  etc.   The average medical report by doctors has exploded into multi-page documents because of requirements of regulation and managed care.

It has become harder and harder to organize and analyze the information.  But the person who has command of the facts can present the information in a manner that can lead to a fast and fair resolution.    

For the injured,  that should be the goal.  The interests of the insurance company, the attorneys, the medical providers, and the regulators should be secondary.  With all the facts organized,  timelined, and presented,  the involved parties should be able to resolve the dispute and begin the process of emotional healing.  

With those interests in mind,  I had the great fortune to have a team of software programmers and medical staff provide expertise and feedback while developing our Software platform.  Our CaseChronology platform allows users to have a comprehensive view of the data regarding a particular event or injury.  

Utilization of the software allows parties to understand the event or injury.  With a more objective view of the facts,   all parties can get to Win-Win.  The emotional healing process can begin.