After an accident the symptoms and complaints you tell the physician about will be critical. This information is crucial in reaching the maximum value for your claim.
Before we proceed, please understand that I am in no way suggesting that you ever tell a physician of symptoms or complaints that you do not actually have from the collision. That may constitute fraud for which there may be substantial economic or criminal consequences.
The first thing to know about the insurance company software programs is that the insurance adjuster will be looking in your medical records for what are called value drivers. Value drivers are medical injuries, symptoms and other matters that the insurance company recognizes as having more value than other injuries, symptoms or matters.
The number one value driver is the amount and type of injuries and complaints your doctor has recorded in your medical records. The International Coding of Disease (ICD) system has created a process where each injury, disease, symptom and complaint has its own ICD-9 code.
When you describe your injury, symptoms and complaints to a physician you do it by words, such as “sore neck” or “back pain”. The physician records your complaints as you recite them. Afterwards, either the physician or a physician’s assistant adds the medical injury ICD-9 codes. It is these ICD-9 codes that the insurance adjuster feeds into the software programs.
The way the insurance company software programs work is that the more ICD-9 codes recorded in your medical records from an accident, the higher the value of your claim. This actually makes sense if you think about it. If one person receives only three separate injuries and another person receives twenty injuries in a collision, then the value of the claim with more injuries should be higher.
I want to make it very clear, again, that I am, in no way, implying or suggesting that you ever attempt to report an injury, symptom or complaint that does not actually exist in you. To do so would be fraudulent and would be completely unethical and wrong. Doing so will destroy your relationship with your health care provider, jeopardize your treatment and could result in you going to jail for insurance fraud.
At the same time, if you truly have any of the symptoms and complaints that I am going to explain to you, you want to make sure to tell your doctor about them. These are ones that the insurance company considers value drivers.
if you truly have them and your physician records them, the value of your claim will increase dramatically. Making sure that your doctor knows about them and records them in your medical chart is only right, since you are simply providing the insurance company with the information they need to give full value to your claim.
Your first opportunity to get all of these value drivers into your medical chart may be in the doctor’s waiting room. This is done by the forms that a patient fills out in the waiting room of the doctor’s office.
In the forms, you will be asked what symptoms or complaints you have from the accident. If you have any of the following symptoms or complaints you want to be sure to write them in the doctor’s patient intake forms. Then you want to repeat them to the doctor when he or she asks you what your symptoms and complaints are.
Again, it is important to remember that these symptoms or complaints must be in the medical records for the insurance company software to give you dollar credits. For this reason, it is imperative that you write them all down in the forms you fill out in the doctor’s waiting room. Then, when asked about your symptoms or complaints by the physician, start at the top of your head and go down body part by body part to your feet, as a sort of checklist to make sure you don’t miss anything.
As indicated above, the types and amount of complaints is the number one value driver to the insurance company. I have organized these complaints in such a way that it will be easy for you to remember which ones to list, should you actually have them. They start with your head and work down through your body.
Head & Brain Injuries
The first five value drivers are all about your head and brain. They are headaches, dizziness, visual disturbance, anxiety or depression and jaw injury. In the waiting room just think about your head and brain and ask yourself if any of these happened to you in the collision. An explanation of each is as follows:
Headaches – Almost everyone who has ever been in a motor vehicle collision, even low impact ones, has a headache. Since the majority of headaches go away within a day or two, most people forget that they had one. The insurance company software programs give a lot of financial credit for headaches (even if it was just a minor headache that went away quickly). Tell the physician, so that he or she can record it in your medical record.
Dizziness – Although people tend to forget about this symptom, it often happens in a motor vehicle collision. After the collision, drivers are often temporarily disoriented. It usually goes away quickly, but if you had any dizziness at all, you need to write it down on the waiting room forms and tell the physician about it.
Visual Disturbances – This is similar, but different than dizziness. The visual disturbance can come in the form of flashing lights or “seeing stars”. Any type of visual disturbance that you experience due to a motor vehicle collision should be reported on the waiting room forms and to the physician. These are value drivers and when a person truly has had them, they increase the value of the claim.
Anxiety or Depression – People who have been in a vehicle collision don’t often like to let others know about it. It is, however, a big value driver and you should disclose it. Almost every client I have interviewed just after a motor vehicle accident appears to be anxious and some are clearly depressed. The physician does not need to be a psychologist or psychiatrist for you to report anxiety and depression in the intake papers or in the examination. Just tell the physician so that it is recorded in the documents. An M.D. is usually licensed to prescribe medications for anxiety or depression. If you need such medications ask for them, fill the prescriptions, take them and add them to your claim.
The combination of the anxiety or depression with prescribed medications becomes an even higher value driver, adding more money to the value of your claim. Also, if a chiropractor records a diagnosis of anxiety or depression and orders non-medication treatment, such as exercise or bed rest, the value of the anxiety/depression claim can also go up.
TMJ – This is an injury to the jaw that sometimes occurs in a motor vehicle collision. At the sides of your head, where the jaw meets the skull, there are small joints named Temporomandibular joints. Those joints are called TMJ joints for short and an injury to a TMJ joint is usually quite painful. The injuries are treated by a dentist with special training in such injuries. Again, this is a value driver and you should make sure it goes into the records.
This disorder also occurs following an accident when a person clenches or grinds their teeth due to the pain and discomfort of the injuries.
Non Head & Brain Injuries
The next three value drivers have to do with parts of your body below your head starting at your neck. They are as follows:
Muscle Spasms – In a motor vehicle collision, the impact stretches the muscle to its extreme length and as a result the muscle and tendon fibers are damaged. The muscle, in an attempt to protect itself, goes into a spasm and becomes hard and stiff. The spasms usually occur to the muscles in the neck or the back. They can, however, occur in the arms, legs and any other part of the body. They are big value drivers, so you want to be sure to record them in the waiting room forms and tell the examining physician about them.
Restricted Range of Motion- When a muscle is in spasm it usually restricts a person’s normal range of motion. For example, if you can normally rotate your head all the way to the left and right, but after a collision can’t rotate as far, your range of motion has become restricted by the collision. The same applies to your back when you can’t bend over or rotate your body right or left the way you did before the accident. Again, it’s a big value driver and needs to be written into the waiting room forms and disclosed to the physician. Most physicians will be performing range of motion testing as part of the physical exam, so the number of degrees of restricted range of motion, compared to normal, will usually be recorded by the physician as part of the examination findings.
Radiating Symptoms- The nerves that go from our necks to our fingers and from our low back to our toes all come out of our spine. The cause of radiating pain is usually some type of injury to the spinal vertebrae, discs or nerves. This is pain, tingling or nerve feeling that starts in one part of your body and then radiate, or travel, towards another part of your body. For example, if you have neck pain after a collision that also travels down your arm to your shoulder, elbow, wrist or fingers, you have radiating pain. If you have back pain that shoots down to your hips, knees, ankles, feet or toes you have radiating pain.
It is important that you tell your doctor about every symptom you have been experiencing since the accident. The following are warning signs of injuries or medical conditions that could have been caused by the collision. Report any of these symptoms to your doctor immediately.
• Headache, Dizziness, Visual disturbance, Anxiety, Depression, Teeth grinding, Jaw pain, Clenching of the jaw, Muscle spasms, Restricted range of motion, Radiating pain
The insurance company is playing by a set of rules that they have not told you about. Under California law, you are entitled to compensation for the injuries caused you by the negligence of the at-fault driver. You need to tell your physician every symptom or complaint that you have suffered from the collision.
TIP: It is imperative that you tell your doctor about every symptom you have experienced since the accident. This information is not only important to your medical treatment and recovery, it is also crucial for your injury claim.
Wishing you good health and safety, John P. Burns, San Juan Capistrano, CA, copyright 2010.