Common Legal Terms
Personal Injury Insurance Claims
Affidavit - A written
statement made under oath. You may be asked to make an affidavit
concerning your treatment and condition of the client.
Allowable -The charges
which the insurance company agrees to cover if all requirements of service
are met
Alternate Dispute Resolution-
Focus
is on finding alternatives to trial as a method of resolving legal disputes.
Includes mediation, arbitration, settlement, conferences, and mini trials.
A trial can be costly and very time intensive without any guarantee you
will get anything. These alternative methods are reduce the time
and cost of settlements.
Ancillary - Assisting
in the performance of a service or achievement of a result
(i.e., massage is ancillary to chiropractic treatments)
Appeal - A request
for a higher court to review a lower court's decisions regarding the outcome
of a case.
Arbitration - Alternative
method of resolving dispute where an individual or panel makes the decision
bases on evidence and testimony presented. Arbitrators are usually attorneys
or retired judges. You may be asked to appear at an arbitration on
behalf of the client to make a statement regarding the treatment, condition,
and future prognosis as to the clients health. Good chart notes are
necessary. This needs to be done before the statute of limitations
runs out which varies state to state. You may charge for your appearance
at an arbitration.
Brief - A written
legal document prepared by an attorney to serve as the basis for a legal
argument.
Claim - Formal
beginning of an injury case initiated when the injured person contacts
the negligent party's insurance company. This must be done within
a certain amount of time after the accident which may vary state to state.
A demand is made for compensation due to injury, loss of work, property
damage, pain and suffering
Deductible- The
portion of the medical expense that is payable by the patient; deductibles
vary per policy and type of coverage
Deposition - A formal
inquiry in which the attorney has the right to ask questions and obtain
information from the parties involved, witnesses, or expert while under
oath. You may be asked to make a deposition regarding the case.
Diagnostic Code -
Numerical codes from the International Classification of Diseases (ICD)
which identifies the illness/injury/condition for which the patient is
to be treated. This information should be provided by the referring
physician. (If not - see Insurance Billing
Codes for the most common)
Independent Medical Exam
- A medical examination ordered by the defendants. The physician
is hired to write a report for them about the injured party's condition.
This usually occurs when the insurance company is starting to question
the treatment condition of the injured person. The report may include such
things as what is viable treatment for the injury and how much longer treatment
will be needed. If your client is requested to go to one, they may
want to seek guidance from a legal advisor.
Interrogatories -
A method of inquiry consisting of written questions submitted by one party
to another party under oath.
Lawsuit - An official
claim or cause of action instituted or pending between two private persons
or entities in a court of law. Some personal injury claims
may end up in a lawsuit if neither party can agree on resolution.
It officially becomes a lawsuit when a complaint is filled with the court
and the defendant is served or given a copy of the complaint.
Lien - Filing a claim
on the property of another to secure payment of a debt. File one
first with the lawyers office . If they refuse to sign for some reason,
file one with your local county clerk's office. Fill out the lien and have
it notarized and send to the county clerk. Be sure that the
lien is removed when the debt is paid.
Mediation - A procedure
used in alternate dispute resolution in which a third party meets with
all parties involved and attempts to settle a complaint or claim.
The Mediator does not make a decision about the case but rather attempts
to get the parties involved to settle on their own. A mediation must be
completed before the statute of limitations runs out. You may be asked
to make a statement regarding the clients injury and treatment. You may
also charge for your appearance.
Medical Release Form -
Before
sending treatment records to a third party, it is required that you receive
a medical release form from the insurance company signed by the injured
party stating that they know you will be sending your medical records to
them.
Personal Injury Protection
(PIP) - Insurance coverage held by the injured party that will pay
medical bills immediately and then settle later with the third party's
insurance. If a person does not have PIP then you will have to wait
until the case is settled which may be quite a long time. PIP policies
also usually have a dollar and time limit that may be used up quickly if
it is a serious injury. You may want to make sure you are treating
under these limits to ensure payments.
Procedure Code (CPT) -Numerical
code which identifies the type of care provided or the procedure used in
that care.
SOAP Charts - Method
of tracking and charting clients progress; Subjective, objective,
assessment, plan.
Statute of Limitations
- Each state has their own law regarding the time frame in which a lawsuit
must be filed. You may have a client who has been injured in an auto
accident and has retained a lawyer to help settle the case out of court.
The threat of lawsuit may be used to encourage the parties to settle.
A lawsuit must be filed before the time limit runs out which in Washington
State is 3 years for personal injury claims.
Subpoena - A written
command requiring a person to appear at a certain time and place to give
testimony at a deposition or other legal proceeding.
Tort - French word
meaning "wrong". Body of Law that determines the rights and liabilities
when property is damaged or a person is injured through negligent or intentional
conduct.
Tort-Feasor- Person
whose negligence caused the accident.
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