Interested In Information Technology That Streamlines the Complex Process of Determining the Greater Weight Of The Evidence In P.I. Claims? Probably So. There is a new process to win the great Weight Challenges now being used to overcome varying opinions.
Independent medical validation utilizes information technology infrastructure that has been specifically designed to streamline the complex process of determining the Greater Weight of the evidence complying with Quality System regulations and client reporting.
My primary service is to conduct IMVs, independent medical validation, with letter of validation to establish the preponderance of evidence to prevent unfair settlement valuation and in the aftermath, to counter such unfair claim settlement valuation and IME denials – disputes – or omissions.
IMV services provide evidentiary burdens of proof to overcome common litigation obstacles in auto accident related claims especially when:
Settlement valuation is low or unreasonable
There are varying medical opinions
Evaluators disagree about the degree of impairments
Adjusters disagree about the type of injuries
IME’s deny or dispute claims
Clinical findings are not obvious
There have been prior accidents or pre-existing conditions
Accident speeds were low and there is no visible property damage
One of the purposes of IMV is to provide authoritative and accurate answers to questions regarding the nature and permanency of medical conditions or personal injury, according to the following factors of the claim:
Do Your Demand Letters Contain These Points To Win The Greater Weight?
Medical, Administrative, Legal & Economic Decision Points
Value Drivers
Injury Severity Points
CASE Maximizers
Prolonged Modifiers
Standard Multipliers
Additional Increase Multipliers
Liability Drivers
Injury Drivers
Mileage Drivers
Undisputed Statements Of Fact
Points Of Memorandum
Evidentiary Burdens Of Proof & Authorities
Medical History
Medical Office Records with Laboratory Tests, Special Tests
and Diagnostic Procedures
Hospital Records
Records From Client
Records From Other Sources
Explanations For Delay In Seeking Care
Explanations For Gaps In Treatment
Functional Physical Examination Review
Injury Types (ICD’s) [25% value of claim]
Symptoms (Documented)
Laboratory Tests
Special Tests
Diagnostic Procedures
Specialist’s Evaluation
Diagnoses (Double Digits)
Complaints – (intensity, frequency, type, radiation, further effects)
Duties Under Duress [25% value of claim]
Loss Of Enjoyment [25% value of claim]
Medical Determination of Future Treatment
Prognosis Overall
Prognosis Each Body Area
Future Treatment Plan
Number of Future Visits (On stable injuries)
Future Treatment Duration and Time Line
MMI For Each Body Part
% Whole Person Impairment with Medical Validation Letter. [25% value of claim]
Evidentiary burdens of proof showing soft tissue injuries meet “Serious Injury Thresholds”
Diagnostic Related Estimates (DRE’s)
Diagnosis Based Injuries (DBI’s)
Spine Impairment Summary
Specific Disorders Of The Spine
Whole Person Impairmen
Do Varying Opinions In P.I. Claims Present Obstacles and Low Settlement Valuation? Probably So. Independent Medical Validation Eliminates Varying Opinions!
I provide attorneys with a 3rd party letter of validation that establishes the Great Weight evidentiary burdens of proof of evidence based data requirements. This is intended to minimize medical, administrative, legal and economic claim burdens and prevent unfair claim settlement valuation. This has been encouraging to plaintiff attorneys.
Based on attorney feedback, it is believed that this process meets and exceeds the needs for one side to win the Greater Weight of the evidence challenges and represent an important core competence and advantage of eliminating varying opinions.
Utilizing logical database requirement and software system attributes, the independent medical validation includes: HIPAA compliance; accuracy; precision; repeatability; reproducibility; reliability; availability; high level security; maintainability; portability; system interface; user interface and communications interface.
IMV’s are now being used by plaintiff attorneys to retort unfair settlement valuation. This gives plaintiff's a distinct advantage when the IMV shows only one (1%) percent more believability which is difficult to oppose using traditional litigation standards.
New “TABLE” Format Required To Input Value Into Colossus
Evidence is presented in the correct language, format and sequence to interface and input applicable value into an insurance claim and prevent unfair settlement valuation. It is now possible to counter Colossus and the other claims determination software’s used by the insurance industry
The need for plaintiffs to retort defense based IME’s and counter Colossus is in high demand resulting in consistent, predictable, increasing and recurrent demand for such IMV services.
To meet and confer, or arrange a presentation delivered in your office or review a medical validation report, please contact me directly.
DO YOU WISH YOUR TREATING PHYSICIAN COULD COUNTER THE CLAIMS ASSESSMENT SOFTWARE’S (COLOSSUS) WITH “VALUE DRIVERS” THAT ENHANCE SETTLEMENT VALUE? Probably So. Colossus Can Assess more than 600 injury types and physicians who know what they are can help enhance settlement valuation.
DO YOU WANT TO KNOW WHICH “VALUE DRIVERS? AND “DECISION POINTS” CAN ADD VALUE TO THE CLAIM? Probably So. The Following Factors Should Be Included In Every Medical Chart And Legal Demand.
OVERLOOKED “VALUE DRIVER” INJURY TYPES CAN ADD SIGNIFICANT VALUE INTO A COLOSSUS CLAIM.
Mild traumatic brain injuries [Five (5) types of common concussion]
Upper cervical ligament tears [728.4 = 25% whole person impairment]
Sensory nerve loss
Muscle weakness [Motor Loss]
Radiculopathy
Specific Disorders Of The Spine
Diagnoses Based Injuries
Diagnostic Related Estimates
Loss range of motion of joints
Whole Person Impairment
Uncinate process fracture [Minimal derangement fracture of vertebra at low speeds].
As seen In the 5th edition of the guides, chapter 15, table 15-3a-c, page 379, it tells us ligaments can tear when vertebra have undergone G-forces that cause translation or angular motion of adjacent vertebra induced from the trauma. This injury is referred to in the AMA Guides as “AOMSI” or Alteration Of Motor Segment Integrity. Research reveals these injuries can occur with as little as an 8.2 mph rear end collision.
The latest edition Guides heavily weighs nerve disorders as radiculopathy which can be diagnosed with monofilaments, NCV and provocative neuro-compression orthopedic tests. Heavy value is given to radiculopathies as they cause weakness of muscles, diminished deep tendon responses or sensory changes affecting the skin as paresthesias, etc.
Nerves get injured and pinched and Colossus can trace these injuries into full peripheral involvement.
DO YOU WANT TO KNOW ‘INSIDER INFORMATION ON HOW SETTLEMENT VALUE IS EITHER LOST OR ACCEPTED INTO COLOSSUS? Probably So. Insurance companies’ “insider secrets” reveal methods to enhance settlement valuation.
To use their claims settlement software’s as Colossus, an adjuster inputs data referred to as “Decision Points” and “Value Drivers” about a claim and Colossus calculates a range of values for the claim's worth. The Colossus program can evaluate more than 600 injuries, according to Marion Kelley, representative of Computer Science Corporation (CSC), the company that developed Colossus.
TO THE DEGREE THAT THE DOCTOR PROVIDES ADEQUATE MEDICAL FILE CHART NOTES DETAILING THE MEDICAL FACTORS LISTED BELOW, THE CLIENT CANNOT GET A FULL SETTLEMENT EVALUATION ON THE CASE.
“POINT TO DOLLAR TRANSLATION PERCENTAGE MULTIPLIER” FORMULA
Extracting As Many Of The Following Dollar Point Value Factors And Including Them In The Demand, Will Maximize Settlement Value.
The insurance companies software’s use these factors in their determination of settlement value, which if missing in your demand = missing settlement value and dollars.
14,357 “Value Drivers”
27,125 “Severity Drivers”
33 “Liability Drivers”
15 “Additional Increase Multipliers”
26,350 “Standard Multipliers”
67,880
TOTAL DECISION POINTS
INSURERS ALSO USE:
Case Maximizers
Injury Severity (Dollar) Points
Prolonged Modifiers
TO THE DEGREE THAT THE DOCTOR PROVIDES ADEQUATE MEDICAL FILE CHART NOTES DETAILING THE MEDICAL FACTORS LISTED BELOW, THE CLIENT CANNOT GET A FULL SETTLEMENT EVALUATION ON THE CASE.
“POINT TO DOLLAR TRANSLATION PERCENTAGE MULTIPLIER” FORMULA
Insurer’s Have Colossus – Now You Have Zeusdemand To:
Prevent Unfair Settlements
Eliminate Varying Opinions
Establish the Preponderance That Meets Evidentiary Burdens of Proof
Win The “Greater Weight” of the Evidence Challenges
Formulate A New Style Demand
ZEUSDEMAND also incorporates a proprietary INJURY CASE CLAIM SETTLEMENT CALCULATOR that automatically;
Locates, tags and extracts “decision points” and “value drivers” that input value into a Colossus claim and formulates a case demand in the correct language, format and sequence to input value. It cites the vital information that comes from combining your case facts with relevant medical, administrative, legal and economic Decision Points and Value Drivers that determine settlement value – all in one interactive tool.
Sweeps the file for any MISSING Decision Points or Value Drivers of each case, so they are not overlooked leading to unfair settlement valuation.
Saves tremendous time in compiling relevant records and producing demands.
Utilizes the ratings from the Quality Systems (QS) of the medical industry to calculate a whole person impairment as evidentiary burden of proof of injury to establish the preponderance of evidence, eliminate varying medical opinions and win the GREAT WEIGHT Challenges.
Decision Points Are The Key In Determining Settlement Valuation
FREE Use Of Zeusdemand
To see a working copy of Zeusdemand, simply contact me.
Are you interested in countering varying opinions that almost always exist on P.I. cases? Probably so. This strategy might keep you from receiving unfair settlement valuation.
The following information addresses possible solutions for the multitude of challenges personal injury plaintiff attorneys face along with how to prevent unfair or low-ball settlements.
WARNING: Some of the information contained within can be disturbing as you discover external limitations which have largely been out of your control, until now. However, vital data can be used to prevent unfair settlements, eliminate varying opinions, establish preponderance, meet court approved evidentiary burdens of proof to win the presumptive “Great Weight” challenges.
WITHOUT THIS INFORMATION, IT CAN RESULT IN UNINTENDED AND DISASTROUS CONSEQUENCES IN SETTLEMENT VALUATION.
Since 2004, the average injury claim case settlement reserve has dropped from $15,800 to $5,080. Plaintiff attorneys are refusing to accept injury claims unless there are serious injury thresholds. That’s because insurers hired consultants who created Business Process Improvement (BPI) which introduced software programs to determine and lower claim settlement valuation. Almost all the insurance companies now use claims settlement software’s to determine settlement value. As the software’s engage cost containment measures to limit bodily injury settlements, it has made it difficult for plaintiff attorneys to oppose without specific knowledge of how the system works.
To understand how this is vastly different from how claim value had been determined previously, it starts by recognizing that there are now 80 different claim settlement software’s in use of which Colossus was the first.
HOW TO BULLET PROOF THE APPORTIONMENT RATING
The courts set forth five components of an apportionment determination that can be used as a checklist to ensure a doctor’s report is bullet proof on the issue.
Dr. must make a specific apportionment determination, using percentages, based on the permanent impairment or disability that existed at “the time of his (or her) evaluation of injured. (It’s fine if one of the percentages is 0% and the other is 100%, but there must be a specific determination.)
Dr. must analyze permanent impairment or disability based on causation of impairment or disability (rather than causation of injury);
Dr.’s opinion “must not be speculative, it must be based on pertinent facts and on an adequate examination and history;”
Dr.’s opinion must be based on “reasonable medical probability;”
Dr. must explain how and why he or she arrived at his conclusion.
When dealing with an issue of apportionment, prudent practitioners will use the “bullet proof” points discussed above as a checklist to ensure they hit all the marks.
I follow the bullet proof points and use an electronic Medical Record System named Zeusclaim, designed specifically to counter Colossus and varying opinions. It assists me to search, tag and extract all the “Decision Points” that commercial auto insurers use to assemble, interface and input value into a 3rd party, commercial insurer Colossus claim. You’ll discover that my system can save legal time and spend related to the formulating of a demand and in establishing preponderance, winning the Greater Weight of the evidence challenges and eliminating varying opinions especially in the presence of prior accidents and pre-existing conditions, or when apportionment is required.
To further substantiate guidelines and causation, I list my findings of body part/system/function involved and cite the percentage of impairment referencing AMA Guide Edition, Chapter, Table# and page# and assemble the data in a “TABLE” format as required to interface and input value into a Colossus claim. One of the purposes of citing impairments and placing them in “table” format (as seen below), is to produce enough evidence- based data by one side to create a belief that its version is more likely true than not.
The establishment of impairment rating and using “table” format is to present SUBSTANTIAL EVIDENCE which consists of: Reasonable Medical Probability (RMP), Causation, Evidence, Germane Facts, Adequate Examinations, Reasoning – The “How” And “Why” and also Conclusionary Evidence to meet evidentiary burdens of proof in admissible format to establish preponderance, eliminate varying medical opinions and show the Greater Weight of the evidence.
In Labor Code Section 4663
In the noteworthy panel decision of Thomas v. Long Beach Unified School, 2012 Cal. Wrk. Comp. P.D. LEXIS 317, the WCAB set forth the basics as to what constitutes substantial evidence on the issue of apportionment.
The following are three critical portions or provisions of Labor Code Section 4663 as enacted by SB 899 on April 19, 2004 to so apportionment:
(a) Apportionment of permanency shall be based on causation.
(b) Any physician who prepares a report addressing the issue of permanency (impairment or disability) due to a claimed accidental injury shall in that report address the issue of causation of the permanency.
(c) A physician shall make an apportionment determination by finding what approximate percentage of the permanent impairment or disability was caused by the direct result of injury arising out of and occurring in the course of accident or employment and what approximate percentage of the permanent impairment or disability was caused by other factors both before and subsequent to the accident or industrial injury, including prior accidental or industrial injuries.
Did you ever wonder what exactly was on the adjusters mind when you receive an unfair settlement valuation? Probably so. Certain binding insurance adjusters’ “CODES OF ETHICS” are being used against insurers by some plaintiffs to prevent unfair settlement valuation.
CERTAIN BINDING “CODES OF ETHICS OF AN ADJUSTER" STATE THAT;
"The work of adjusting insurance claims engages the public trust whereby an adjuster must put the duty for fair and honest treatment of the claimant above the adjuster's own interest, in every instance'
"An adjuster shall approach investigations, adjustments and settlements with an unprejudiced and open-mind'.
"An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation”… and
"An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition thereof'.
Further stated in Ethics Codes of an Adjuster;
"Where an insurer denies or rejects a first party claim, in whole or in part, it shall do so in writing and shall provide to the claimant a statement listing all bases for such rejection or denial and the factual and legal bases for each reason given for such rejection or denial which is then within the insurer's knowledge”.
The plaintiff attorney can make a request for admissions to determine what factors of the claim were disputed, omitted or denied. Such request for discovery can be based on the fact that the possibility in any given day, with respect to responsive communications, factors have come up on diary and may go unanswered or are for any other reasons, not memorialized in the claim notes.
Such is the plaintiffs reason for requesting to see what “Value Drivers” and “Decision Points” of the claim were accepted, omitted, denied or disputed. This accounts for considerations of the; injury types, Duties Under Duress, Loss Of Enjoyment, stability of the medical condition, prognosis, medical determinations, future treatment considerations, future costs, medical validation and percentage of whole person impairment that constitute some of the reasons for the respectful demand.
Insurance Regulations Call For Documentation Of Claim Factor Denials:
Upon receiving proof of claim, every insurer, except as specified in another subsection, shall immediately, but in no event more than forty (40) calendar days later, accept or deny the claim, in whole or in part.
The amounts accepted or denied shall be clearly documented in the claim file unless the claim has been denied in its entirety.
