Medical records and
bills
One of the most important steps in making
an insurance claim or preparing a dog bite lawsuit is gathering the medical
records. "Medical records"
include:
-
Ambulance "run" records
-
Paramedic (fire department) "run" records
-
Emergency room records (frequently maintained
in a separate location at many hospitals)
-
Hospital records, including examinations,
consultations, nurses' notes, test results, operative reports, admission
and discharge summaries, and more
-
Private physician records of exams, treatment
and consultations
-
In-home nursing records
-
Physical therapy records
The medical records are kept separate from
the medical billings. The billings must include the standard codes for
descriptions of services, the dates of treatment, and the itemized charges
on each date. The billings also must show the gross amounts charged, as
opposed to the net charges after receipt of payments or application of
discounts.
How the medical
records and bills are gathered
Medical records must be gathered by an experienced
copy service that knows where to look for them. The copy service will provide
a certified copy of the records that can be introduced into evidence in
a court case, and insurance companies will accept as being correct and
complete.
Copy services are difficult to deal with,
however, because they usually are slow and the work is not exactly stimulating
for the employees. Therefore a lot of supervision is required. Mr. Phillips
retains a nurse for each claim, whose duties include supervising the gathering
of the medical records and bills as well as analyzing them and writing
a comprehensive summary and analysis of them (discussed below).
Copy services charge a significant amount
to copy records. This cost is advanced by the attorney who handles the
claim, and is recouped from the settlement or judgment if any.
Analysis of medical
records
After the copy service gathers all the medical
records, they are analyzed by the nurse retained by Mr. Phillips. The nurse
writes a comprehensive summary that is suitable for the insurance claim.
Mr. Phillips independently reviews that medical records and bills, as well
as the analysis by the nurse.
Prognosis reports
Serious cases require future medical services
and associated treatment costs (as well as disability and loss of income
during the period of recovery, and increased pain and suffering from the
impact of the services and recovery). The medical records pertain to past
services rendered, but rarely contain a "prognosis" (i.e., a reasoned prediction
about a medical condition). It is Mr. Phillips' job to recognize the medical
issues that require a prognosis report, so that the insurance claim will
be complete and the settlement (if any) will provide a sufficient amount
of funds to cover the future effects of the dog bite injuries.
A prognosis report may include the following
points:
-
A brief history of the patient's condition
-
Treatments and tests required in the future
-
The costs of treatments and tests performed
in the future
-
Operations required in the future, such as
scar revision
-
The costs of the operations, including the
surgeon, anesthetist, assistants and surgical facility
-
The probable outcome of the treatments and
operations expected to be performed in the future
-
The success rate of the treatments and operations
expected to be performed in the future
-
Possible complications of the treatments and
operations expected to be performed in the future
-
The length of time probably required for recovery
from the future treatments and operations
-
Disability to be probably expected as a result
of the future treatments and operations
It is important to understand that a physician
who writes a prognosis report is expected to relate what might occur based
on reasonable medical certainty -- not complete certainty.
Medicine is as much an art as a science. Anything might possibly happen,
but the law is not interested in remote possibilities when fixing compensation
for a victim. The law needs to know what is probably going to happen, based
on reasonable medical certainty.
www.dogbitelaw.com
and each of its sections, including Dog Bite Law , The Dog
Bite Law Adviser and the foregoing text, are (c) 1999-2005 Kenneth Morgan
Phillips. All rights reserved. Reproduction in whole or part prohibited except
where advance permission is granted in writing.