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When assessing a personal injury claim for damages, a very important trait that EVERY CLIENT looks for in a lawyer is whether or not the lawyer is capable of winning their case in court, or negotiating out of court for the best settlement possible.

But how do you find the right lawyer to help you with your claim? All lawyers should have the academic and professional qualifications to practice law, and every advertisement should comply with the advertising restrictions set out by the Personal Injuries Proceedings Act 2002. Why? Simply, a credible legal professional must advise you on maintaining and protecting the credibility and integrity of your legal claim. Unethical lawyers who do not adhere to their responsibilities to the court and to their clients may adversely affect your legal rights.

A key component of compensation is special damages. These types of damages are easily calculable and are often proven through receipts, invoices, account records, etc. Medical costs fall under this category and are one of the most important forms of compensation available to personal injury claimants.

It is important to find a personal injury lawyer who has experience in dealing with medical cost issues against the insurance company. Inexperienced lawyers may make serious mistakes in your claim such as the following:

  • Accepting the conclusions drawn by an insurer independent medical examination (IME) without consulting you or considering a second opinion;
  • Failing to understand medical terminology and drawing the wrong conclusions concerning your injuries and your legal rights;
  • Confirming whether or not your injury has peaked and your claim is ready for settlement; or
  • Failing to account for all necessary medical treatments you should be entitled to for your claim, including potential psychological treatment or assistive devices or attendant care.

How do claims officers assess medical treatment?

When claims officers assess the validity of medical treatment, they recognize that not all medical services are ‘equal’. Sadly, the insurance company has a strong bias on mainstream treatment by doctors, hospitals and medical clinics.

This is an important consideration because the treatment you seek may affect how a claims officer perceives the severity of your claim to be. Many clients get frustrated and anxious when they are told by the insurance company that their injuries are considered ‘minor’ simply because they have tried to ‘put up with it’ in the hope it would get better.

What this basically translates to is a potentially lower estimate for compensation on the part of the insurance company. It is important that you protect your rights by speaking with a personal injury lawyer.

What are the variables that insurance companies use when assessing treatment?

When assessing how much to compensate you for medical treatment, some of the variables that the insurance company will take into account include:

  • Whether a doctor has diagnosed an injury that requires such treatment;
  • The potential usefulness of that treatment; and
  • Whether it is reasonable in terms of the amount of treatment required and the care thereof.

Diagnosis or Treatment?

An injury is required to be diagnosed before it can be treated. In most cases, this process should be relatively quick and the charges should be proportionately less compared to the costs of actual treatment. In this case, a claims officer does not usually make a distinction between diagnostic or treatment costs. They will simply lump all of your medical bills into a single special damages amount.

However, a sad possibility for some clients is when doctors undertake numerous tests and examinations to simply determine what is wrong. In the worst case scenarios, this tactic is simply a way for a less than credible person to run up larger medical billing.

An insurance company may flag this occurrence as an inaccurate reflection of your actual injuries, pain and suffering.

Physiotherapy

A large number of clients pursue physiotherapy as a common treatment. However, such treatment considered over an extended amount of time may be seen by an insurance company as unnecessary and will be apportioned in their settlement amounts accordingly with this mentality.

The difficulty of this particular issue is how the physiotherapy is sought. Often, the best way to be considered for physiotherapy is to have a doctor prescribe it. Yet, clients may opt to pursue such treatment on their own and this may be seen as unfavourable to the insurance company who prefer treatment recommended by a doctor.

Doctors vs. Alternative Treatment

Acupuncture, Chinese medicine and other forms of non-conventional therapy are generally considered less legitimate compared to medical bills that come from a doctor, hospital or medical clinic.

While clients may claim that alternative treatments may provide more effective relief in some cases, alternative treatment is still given a lower monetary consideration when it comes to settlement.

The challenges of this insurance bias is that alternative treatment may often cost less out of pocket for the client compared to paying a doctor or hospital bill (though Medicare may alleviate some of these costs). However, it is highly advised that when arguing a settlement amount with the insurance company, legal advice is sought. Often, settlement figures may be interpreted as a lump sum instead of individual expenses so how a client presents their case with respect to treatment may be a critical factor in determining the amount of compensation.

Length of Treatment

A general rule of thumb is that more serious injuries require more time to heal. Additionally, a longer recovery time also implies a larger degree of pain and suffering.

However, an insurance company may also interpret such treatment length as unnecessary in some cases.

This is a very serious conflict for clients, especially if the extended period of injury also affects their ability to make an income or take care of their family.

It is very important that a valid argument is made in support of your injury and treatment length. Failing to do so may prolong settlement or worse, result in less compensation for your current and future treatment.

Personal Injury Lawyers Brisbane

If you have any questions about how the law affects your claim settlement, give East Coast Injury Lawyers a call at 1300 720 544 or fill out our review form.