Handling Minor Injury Claims. Presented by: Dana H. Hoffman Young, Moore & Henderson, P.A. dhh@youngmoorelaw.com

Size: px

Start display at page:

Download "Handling Minor Injury Claims. Presented by: Dana H. Hoffman Young, Moore & Henderson, P.A. dhh@youngmoorelaw.com"

Reginald Jennings
8 years ago
Views:

1 Presented by: Dana H. Hoffman Young, Moore & Henderson, P.A.

2 Is this a minor injury claim? Factors to Assess: 1. Physical Damage to Vehicles 2. Accident Report: Injury Status noted by Officer 3. Treatment on Day of Accident 4. Nature of Complaints 5. Type of Treatment

3 How much time and expense should be spent initially? Recorded Statements of Claimant, witnesses? Download ECM? Notify and involve outside counsel? Send accident recon to scene?

4 How much time and expense should be spent at a later stage? Surveillance? Retain biomechanical engineer? Records review by independent provider? IME?

5 DOES THE PHYSICAL DAMAGE TO THE VEHICLES PREDICT THE INJURY TO THE OCCUPANTS?

13 Is the injury status recorded on the Accident Report a predictor of the Claimant s condition?

14 Did the Claimant seek medical treatment on the day of the Accident?

15 Who referred the Claimant for treatment? -Emergency Room Doctor -Attorney -Prior Relationship with Doctor

16 FRAUD Fraud and buildup added $4.8 billion to $6.8 billion in excess payments to auto injury claims in Buildup involves treatment that s excessive but isn t deliberately or criminally fraudulent.

17 FRAUD Claims with apparent fraud or buildup were more likely than other claims to involve sprain and strain injuries, and periods of disability. These claimants also were more likely to receive treatment from physical therapists, chiropractors and other alternative medical providers.

19 74 [State statutes, etc., addressing fraud]

20 FRAUD Types of Suspicious Accidents: Swoop & Squat Sideswipe T-Bone Wave Shady Helper

21 FRAUD vs. EXAGGERATION vs. VALID CLAIM: What is Your Company s Approach? Dedicate time and expense to investigate regardless of cost Offer minimal settlements to close files

22 Red Flags Accident Details: Claimant has prior accidents of similar circumstances. Claimant has multiple past claims with same attorney. Claimant is unemployed. Lack of familiar or personal relationships between occupants of claimant vehicle. Inconsistencies in multiple claimants' versions of seating in vehicle, why claimants were in vehicle, and destination of claimants. Claimant appears to be familiar with claims process and evaluation. Presence of an overly enthusiastic witness at the accident scene. Claimant has recently purchased vehicle, and/or insurance. Victim is usually female or elderly.

23 Is the Claimant exaggerating the severity of the injury? Otherwise known as testing the claimant s credibility. Red Flags Medical Treatment: -Location of pain is inconsistent. Or -Claimant has pain everywhere. Or -Pain does not follow dermatome patterns.

24 Red Flags Medical Treatment: -No improvement (even temporary) with medical treatment & medication. -Lies about past injuries or medical treatment. -Subjective complaints are not supported by objective evidence.

25 Red Flags Medical Treatment: **Medical Provider documents inconsistencies, exaggerated response or questionable complaints. Examples: -No problem walking in parking lot; significant problems during exam. -Can lift arms to take off sweater; cannot lift arm during exam. -Over-reacting to non-painful testing.

26 Red Flags Unnecessary Medical Treatment: -Treatment for mild neck or back strain prescribed for more than 6 weeks. -Questionable treatments, ex: discograms, for soft tissue injuries. -Referrals in-house for different modalities of treatment. -Duplicate treatments, ex: spinal manipulation and manual traction on same visit.

27 PIP vs. Non-PIP STATES

PIP Claiming Behavior and Claim Outcomes in Florida s No-Fault Insurance System

PIP Claiming Behavior and Claim Outcomes in Florida s No-Fault Insurance System Insurance Research Council February 2011 This report, PIP Claiming Behavior and Claim Outcomes in Florida s No-Fault Insurance