Medical File Reviews and Lifetime Medical Cost Projections
At certain times during the handling of a claim file, the Claims Adjuster
needs to organize and sort out complex medical issues in order to make the most
appropriate claims decisions. At question could be issues of compensability,
causality, excessive treatment, inappropriate treatment, appropriate reserves,
the need for further IMEs or Peer Reviews, or simply organizing and making sense
of the complex and lengthy medical treatment documented in the file.
This is where our
Medical File Review program can be help.
With our program the Adjuster can:
- establish a treatment timeline and identify medical necessity and
- determine the need for additional areas of inquiry such as expert
opinions, case management or auditing intervention
- accurately project lifetime medical (and/or lost wages) costs based upon
thorough review of claim file and nationally recognized criteria
A Medical File Review can save the time, effort and expense of setting up
IMEs and Peer Reviews in multiple treatment specialties. With the R.N.s
recommendations, the most appropriate medical experts can be utilized to address
the key issues in the claim.
A Lifetime Medical Cost Projection is an excellent tool for reserving and
preparing cases for settlement, and also provides an important baseline from
which accurate Medicare Set-Aside allocations can be developed. To come up with
a realistic projection, we review all treatment, pharmacy and hospitalization
records and billing, as well as nationally recognized guidelines for medical
treatment and duration. We provide a detailed, confidential report outlining our
findings, itemized projected medical costs and recommendations.