9 Key Questions

Questions To Ask Before Selecting A Doctor

This is information you could use or money you could lose.

Due to the differences in the following areas, it has been stated that an injury claim can be subject to loss valuation by up to 80%. The injury claim should contain 26 vital areas of data. Ask these questions to your doctor before making your final selection.

1. How Many Sections (by number) do You Include In Your Evaluation Of An Injury Claim?

[The doctor should know and record 26 vital and different sections when performing an injury model assessment. Missing areas will translate into missing settlement valuation]

2. Ask and then wait for an answer – What CPT-Code Level Examination Do You Use?
  • 99204 (Medicare) or 
  • 1191M Injury Model?

[It is important that your doctor is trained to perform the 1191M Injury Model Examination on an accident claim VS a 99204 Medicare exam or many factors that determine settlement valuation will be lost]

3. Do You Rate The Following:
  • Whole Person Impairments?
  • Specific Disorders of the Spine?
  • DRE Categories
  • Spine Impairment Summary
  • Injury Severity Types & Trauma Lines

[It is vital that the doctor is trained to perform and include all the above data in your injury assessment. It is reported that Colossus will discount the medical settlement valuation by 25% if the above data is missing]

4. Do You Use Questionnaire’s To Determine; Ligament Damage, Mild Traumatic Brain Injuries & Concussions, Post-Traumatic Stress Disorders, Cervical Chain Ganglia Injuries?

[There are over 100 questions that should be part of the injury assessment and AMA Guides criteria that need to be asked to identify whether any of the above injuries exist]

5. Do you assemble the injuries in a TABLE format?
[The insurers have created “Business Process Improvement” allegedly to improve their ability to evaluate injuries. This requires the physician to create a TABLE showing each body part involved and citing the AMA Guide that was utilized in the assessment and list the chapter, table and page to reference that the exam was done according to AM Guides in a Table format]
6. How Many Diagnoses Do You Tender In An Injury Claim?
[In an injury model, insurers look for ten (10) different diagnoses to fully represent the effects of the accident. If the doctor is trained in the “Injury Model Assessment”, he will be able to identify all the 10+ injuries normally seen in soft tissue cases.]
7. Do You Give A General Prognosis Or A Different Prognosis For Each Body Part Involved?

[Most doctors are trained to tender a general prognosis, however, to represent an injury claim; a different prognosis is required for each diagnosis]

8. Do You Assign Each Injury A Stable and Static Diagnosis?
[Injuries occur to different parts of the body and can include emotional factors as well. See our website for a listing of some of the injuries that occur. Insurers’ ask when each injury will be “STATIC”, or when there is no longer a need for treatment, VS which injuries will need more care known as “STABLE” injuries.]
9. Do You Send the completed medical File to an Independent, Medical, 3rd Party examiner to validate your medical assessment and show that your findings meet evidence-based burdens of proof?
[The court authorities call for a 2nd medical opinion other than the treating doctors and have created the process of “Independent Medical Validation” (IMV) to eliminate varying medical opinions and disputes and show whose opinion carries the greater weight of the evidence. Your doctor should be referring your completed file for this court-approved assessment or you will not be able to successfully defend against the insurance companies disputes]
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