Medical Expert Referral Service USA

Why does healthcare related lawsuits need medical record review?

For a medical lawsuit, detailed review of all the medical records is vital. Medical Record Review is a systematic summary of a patient’s Electronic Health Records (EHR) in a chronological order, with easy to understand and searchable view. It will give the viewer complete details regarding his/her injury from the date of injury to most recent hospital visit.

Medical record review is a very important part in the litigation process when dealing with personal injury claims, medical malpractice claims, product liability claims, disability claims, insurance claims and workers compensation claims. Also medical record review helps the viewer whether appropriate care was provided to the claimant from health care system. It also helps the attorneys to calculate future hospitalization cost, operation cost and other cost incurred by the claimant and help to increase the settlement value.

Medical records contain information such as patients injuries, complaints, lifestyle changes, pain and suffering, diagnosis, medications, treatments, therapies, procedures. These information serve attorneys to substantiate a claim and win their respective cases. Usually the paralegal are involved in medical record review but it is time consuming. Attorneys dealing with these cases will have to go through all available evidences in detail, which can be quite time consuming. Our tailormade services will reduce your medical record review time and free up skilled paralegal staff for more important tasks. It will improve screening for merit, identify problem cases in medical record earlier and more accurately determine settlement values.

Cases we summarize:

Medical Record Review for Personal Injury Cases

Personal Injury Case Review in USA

Personal injury is a legal term for an injury to the body, mind or emotion. Personal injury lawsuits are filed against persons or entity that instigated damage through negligence, reckless conduct and in some cases on the basis of liability. The claim is compensated by the injured person’s medical bills, pain and suffering and diminished quality of life.

To hold a party liable for injuries an attorney need to prove four elements:

  • The party had a duty to act reasonably according to the circumstances.
  • The party breached the duty.
  • The party’s breach of the duty caused the plaintiff to be harmed.
  • Plaintiff suffered monetary damages.

The amount of compensation for a personal injury claim will depend on the severity of the injury. Serious injuries (such as amputations, paralysis, traumatic brain injury, permanent disabilities and death) that cause extreme physical pain and suffering receive the highest injury settlements. Proof of such injury requires more than the injury itself – it requires the medical documentation to back up the case in court. This includes documents from the treating organization, right from the first consultation till the time the case comes to court.

Case focus for medical record review in personal injury cases

  • Timeline. Medical records should be chronologically arranged from claimant’s initial date of treatment to the most recent visit. The proof of the injury, as well as the treatments provided, have to be clearly mentioned to strengthen the case.
  • Showing proof of no pre-existing conditions as defendants could argue that pre-existing conditions led to increase in cost of medical treatment.
  • Upcoming treatment, as it can be vital to the strength and success of a future claim and, consequently, victims’ financial recoveries.
  • Determine the causes of an injury and severity of injury and its long term effects.
  • Establish whether there is permanent disability or the individual can return to work.
  • Convey medical results whether the individual can benefit from future treatment or not.
  • Finding missing records.
  • Likelihood of recovery.
  • Economic damages and non-economic damages. Economic damages such as costs and losses, present and future medical bills, lost income and earning capacity, effect of the injuries on lifestyle, work, family, and other important aspects of life. Non-economic damages such as pain and suffering, emotional and psychological trauma, mental disability, lot of emotional upheaval.

Types of personal injury cases:

  • Car accident.
  • Motorcycle and cycle accident.
  • Pedestrian accident.
  • Accidents in working site.
  • Lifting injuries.
  • Slip and fall injuries.
  • Public transport accidents.
  • Sports injury.
  • Dog bites/animal bites.
  • Brain and spinal cord injuries.
  • Birth injuries.
  • Boating accidents.

Medical Malpractice

Medical Malpractice Case Review Service USA

Medical malpractice occurs when a health care professional or provider neglects to provide appropriate treatment, omits to take an appropriate action, or gives substandard treatment that causes harm, injury, or death to a patient. The malpractice or negligence normally involves a medical error. This could be in diagnosis, medication dosage, health management, treatment, or aftercare. Medical malpractice law makes it possible for patients to recover compensation from any harms that result from sub-standard treatment.

A health care professional is expected to provide a certain standard of care. The professional is legally responsible if the patient experiences injury because of substandard quality of care.

For medical malpractice to be considered a number of factors must be involved, these are:

  • Failure to provide a proper standard of care.
  • An injury results from negligence. The patient must prove that negligence caused injury or harm, and that, without the negligence, it would not have happened.
  • The injury must have damaging consequences. Considerable damage could be suffering, enduring hardship, constant pain, considerable loss of income, disability.

Case focus for medical record review in medical malpractice cases

  • Should show that physician acted negligently in rendering care.
  • Negligence resulted in injury.

Types of malpractice

  • Misdiagnosis or failure to diagnose.
  • Delayed diagnosis.
  • Dental malpractice.
  • Unnecessary or incorrect surgery.
  • Premature discharge.
  • Failure to order appropriate tests or to act on results.
  • Not following up.
  • Prescribing the wrong dosage or the wrong medication.
  • Leaving things inside the patient’s body after surgery.
  • Potentially fatal infections acquired in the hospital.

Nursing home negligence

Neglect occurs when residents are not properly cared for, resulting in physical harm, illness, or even death. When the standard care is not met by care providers in nursing homes, the resident suffers great physical and mental health problems.

Case focus for medical record review in nursing home negligence

  • Failing to administer medications when needed.
  • Not regularly moving seniors with mobility issues, putting them at risk of bedsores.
  • Not reporting signs of infections or illnesses.
  • Improper care for existing health problems like diabetes or dementia.
  • Fail to provide canes, wheelchairs, or walkers to residents with mobility limitations.
  • Isolating vulnerable residents.
  • Not properly bathing a senior.
  • Not changing the clothing or bedding of seniors who soil themselves.
  • Providing seniors unsafe food or water.

Warning signs of nursing home neglect include:

  • Bruises, lacerations, skin tears, broken bones, and other unexplained injuries.
  • Bedsores (pressure ulcers/pressure sores).
  • Malnutrition.
  • Dehydration.
  • Burns, often accidentally self-inflicted.
  • Personal hygiene issues.
  • Insomnia/sleep loss.
  • Significant personality changes.
  • Excessively using restraints (physical or medical) on a resident.
  • Giving incorrect or ineffective doses of medication over long spans of time.
  • Consequences of nursing home neglect: Bad odor, dirty skin, recurring sicknesses or injuries, weight loss, dehydration, anemia, fatigue, personality changes (like depression, anxiety and fear), loss of trust in others, insomnia or sleep loss, suicidal thoughts or actions.

Mass tort

Mass Tort Medical Record Review Services USA

Medical Record Review of Mass Tort Claims

A mass tort is a single wrongful action that causes injury to many different people. These injured people can come together in a single mass tort lawsuit, seeking justice for their various injuries against just one defendant (or maybe a few). Mass tort actions can make it much easier for plaintiffs to succeed against giant defendants like product and medication manufacturers.

The lawsuits arise out of the defendants causing numerous injuries through the same or similar act of harm (e.g. prescription drug, medical device, defective product, train accident, plane crash, pollution, or a construction disaster).

What Are Mass Torts?
A Mass Tort is a case where many people are wrongfully harmed in a similar way, by a similar product. Often by a drug, medical device or defective product, a recent example is the Takata airbag recall, which affects millions of cars.

Case focus for medical record review in mass tort cases

  • Causation of injury.
  • Demographic identification.
  • Medical procedure data.
  • Product ID.
  • Significant procedures and surgeries, per relevant product.
  • Plaintiff fact sheet preparation.
  • Evaluate questionnaires for medical merit and clinical issues.
  • Determine which medical records are pertinent to mass litigation.

Social security disability

Social Security Disability Medical Records Services USA

When you’re seeking compensation for an injury after any kind of accident, there’s a good chance you’ll be dealing with an insurance company. For example, if you get into a car accident, you (or your attorney) may talk settlement with the at-fault driver’s car insurance company. If you file a personal injury lawsuit after a slip and fall, the property owner’s homeowner’s insurance or liability insurance is probably going to kick in.

Medical record reviews are required for medical as well as legal purposes. Accurate review of medical records is important for insurance companies to help them ensure a fair claim settlement in personal injury, medical malpractice and other medical litigation. Insurance medical record review must be accurate and thorough because it is imperative to prove fairness, medical necessity, fraud, embellishment, and up-coding among other aspects.

Case focus for medical record review in social security disability/insurance claims

  • Prior history. Diagnosis, medications, that could prove to be a potential defense.
  • Missing information in the records that may prove valuable at some stage or other.
  • Whether the diagnosis given by physician is accurate, and whether the treatment/care given is reasonable or necessary.
  • Actual expenses (i.e.medical bills) incurred, and those that will be incurred in the future.
  • Lost income or lost ability to make a living.
  • Pain and suffering.
  • Photographs, medical records, and itemized statements of all bills paid and work lost are all essential to maximizing your recovery.
  • Demand letter. This is a letter in which you spell out your side of the underlying incident and state what you will accept in order to settle the case.
  • Capturing all the details provided by independent medical examiner.
  • Medical expenses.

Medical Record Review for workers compensation claims

Employers are legally obligated to take reasonable care to assure that their workplaces are safe. Nevertheless, accidents happen. When they do, workers compensation insurance provides coverage.
Workers receive benefits regardless of who was at fault in the accident. If a worker is killed while working, workers comp (as it is often abbreviated) provides death benefits for the worker’s dependents.

Workers’ compensation

Medical Records Review for Workers Compensation Cases in USA

Workers’ compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee’s right to sue his or her employer for the tort of negligence.

Case focus for medical record review in workers compensation cases

  • New diagnoses after the injury.
  • Lost income or lost ability to make a living.
  • Pain and suffering.
  • Photographs, medical records, and itemized statements of all bills paid and work lost are all essential to maximizing your recovery.
  • Capturing all the details provided by independent medical examiner.
  • Detailed list of all physicians seen for the injury. This will help ensure that a comprehensive and accurate medical history of the injury.
  • Determine whether there is any permanent partial disability due to the injury. To review the relevant medical records that document the injury.
  • Information like partial disability, reduced capacity, claimant is unable to return to his/her original job, but may be able to work in some other job.
  • When the injury does not allow the claimant to work regularly in any capacity.
  • When there are pre-existing disabilities.
  • When there are planned surgery in office visits.
Medical record review services include

  • Sorting: It means organizing medical records in a chronological order. The EMR usually sent to attorneys from a facility does not have an accurate order and the records are piled up. We help in organizing the medical records in date order as it helps in easy view.
  • Medical record summaries: It consist of a chronological summary of events that happened to the claimant from the date of injury to current date in a searchable document. It helps attorneys for preparing for the trial and for exhibits and witnesses.
  • Medical Billing: It provides concise summary of medical bills acquired by the claimant for his injury treatment. Attorneys use this for analyzing the expenditure done by claimant and to demand a better settlement.
  • Hyperlinking: It is the process of merging chronology with source records into a single PDF document. Clicking the page number in the chronology will take you to the corresponding page in the source PDF. It helps in easy navigation to original records and helps in saving time.
  • DICOM Review: Best & clear images of MRIs/X-Rays/other diagnosis images from CDs/DICOM is converted to printable formats. It helps in quick view of the reports and assess the severity of injury. Also, helps in preparing exhibit.
  • Bookmarks: Bookmarks are clickable table of contents list which help you to easily navigate even around smaller medical records. You can quickly locate any key points you are looking for to develop your case.
  • Timeline: It provides a view of how an injury progressed and current status of the injury. While looking at an timeline one can easily understand the events happened after injury in a one page view.

An experienced medical record review company can make the entire record review process simple and efficient. With easily accessible medical record reviews, attorneys and physicians serving insurers and the insured individuals can save considerable time and effort. However, these reviews have to be comprehensive, accurate, timely and adequate enough for the lawyers and paralegals that are not medically trained, to understand the medical aspects and prepare their case well. Similarly, timely review of medical records helps healthcare systems to evaluate the overall care given to their patients, identify risk areas, plan improvements and thereby offer a rewarding patient experience. Apart from this, regular monitoring and review of medical records will help avoid unnecessary expensive treatments and thus reduce healthcare costs.

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