Explorations in the Theory and Practice
Personal Injury Insurance Claims
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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.
whose negligence caused the accident.
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